Provider Demographics
NPI:1720398027
Name:CENTER FOR BEHAVIORAL MEDICINE INC
Entity Type:Organization
Organization Name:CENTER FOR BEHAVIORAL MEDICINE INC
Other - Org Name:ROCKY RIVER BEHAVIORAL PEDIATRICS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NORTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:440-331-4884
Mailing Address - Street 1:19111 DETROIT RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1740
Mailing Address - Country:US
Mailing Address - Phone:440-331-4884
Mailing Address - Fax:440-331-4804
Practice Address - Street 1:19111 DETROIT RD STE 103
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1740
Practice Address - Country:US
Practice Address - Phone:440-331-4884
Practice Address - Fax:440-331-4804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6068103TC2200X
OH103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty