Provider Demographics
NPI:1245299239
Name:ADVOCATES FOR BEHAVIORAL CHANGE
Entity type:Organization
Organization Name:ADVOCATES FOR BEHAVIORAL CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:E.
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-434-7820
Mailing Address - Street 1:628 TWIN PONDS RD
Mailing Address - Street 2:
Mailing Address - City:BREINIGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18031-1843
Mailing Address - Country:US
Mailing Address - Phone:610-434-7820
Mailing Address - Fax:610-434-8210
Practice Address - Street 1:628 TWIN PONDS RD
Practice Address - Street 2:
Practice Address - City:BREINIGSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18031-1843
Practice Address - Country:US
Practice Address - Phone:610-434-7820
Practice Address - Fax:610-434-8210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006290L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1757627OtherHIGHMARK BLUE SHIELD
PA02319500OtherCAPITAL BLUE CROSS/CAIC
PA577527Medicare ID - Type Unspecified