Provider Demographics
NPI:1649571928
Name:VITAL BEHAVIOR SERVICES, INC
Entity Type:Organization
Organization Name:VITAL BEHAVIOR SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MAT
Authorized Official - Phone:516-984-5761
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-0900
Mailing Address - Country:US
Mailing Address - Phone:845-765-0463
Mailing Address - Fax:516-706-1418
Practice Address - Street 1:2004 LYNDHURST WAY
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-7159
Practice Address - Country:US
Practice Address - Phone:845-765-0463
Practice Address - Fax:516-706-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-09-5531251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health