Provider Demographics
NPI:1720542830
Name:FAMILYCARE BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:FAMILYCARE BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETRICK
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:408-835-0048
Mailing Address - Street 1:5669 SNELL AVE # 451
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3328
Mailing Address - Country:US
Mailing Address - Phone:408-835-0048
Mailing Address - Fax:650-434-0749
Practice Address - Street 1:5669 SNELL AVE # 451
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3328
Practice Address - Country:US
Practice Address - Phone:408-835-0048
Practice Address - Fax:650-434-0749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty