Provider Demographics
NPI:1598531055
Name:BLACK BEHAVIORAL HEALTH NETWORK INCORPORATED
Entity Type:Organization
Organization Name:BLACK BEHAVIORAL HEALTH NETWORK INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:413-348-3452
Mailing Address - Street 1:287 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1812
Mailing Address - Country:US
Mailing Address - Phone:413-348-3452
Mailing Address - Fax:
Practice Address - Street 1:287 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1812
Practice Address - Country:US
Practice Address - Phone:866-462-2461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health