Provider Demographics
NPI:1821573023
Name:OCTAVE PSYCHIATRY BEHAVIORAL HEALTH PC
Entity Type:Organization
Organization Name:OCTAVE PSYCHIATRY BEHAVIORAL HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP REVENUE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KYM
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-504-2289
Mailing Address - Street 1:286 MADISON AVE FL 22
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6368
Mailing Address - Country:US
Mailing Address - Phone:917-473-8869
Mailing Address - Fax:929-529-6277
Practice Address - Street 1:286 MADISON AVE FL 22
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6368
Practice Address - Country:US
Practice Address - Phone:917-473-8869
Practice Address - Fax:929-529-6277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty