Provider Demographics
NPI:1760756852
Name:UNIVERSITY BEHAVIORAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:UNIVERSITY BEHAVIORAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WETZLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-920-4920
Mailing Address - Street 1:111 E 210TH ST
Mailing Address - Street 2:ATTN: SCOTT WETZLER, PHD
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2401
Mailing Address - Country:US
Mailing Address - Phone:718-920-4920
Mailing Address - Fax:718-798-1816
Practice Address - Street 1:334 E 148TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5707
Practice Address - Country:US
Practice Address - Phone:718-401-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management