Provider Demographics
NPI:1437271723
Name:COMMUNITY BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:COMMUNITY BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:DIAMOND
Authorized Official - Last Name:KROP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-372-6645
Mailing Address - Street 1:1212 NW 12TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-3032
Mailing Address - Country:US
Mailing Address - Phone:352-372-6645
Mailing Address - Fax:352-373-1237
Practice Address - Street 1:1212 NW 12TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-3032
Practice Address - Country:US
Practice Address - Phone:352-372-6645
Practice Address - Fax:352-373-1237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0002364103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39673Medicare ID - Type UnspecifiedMEDICARE B GROUP NUMBER