Provider Demographics
NPI:1255804167
Name:COREY & CYNTHIA F. DABNEY BEHAVIORAL HEALTH HOSPITAL
Entity type:Organization
Organization Name:COREY & CYNTHIA F. DABNEY BEHAVIORAL HEALTH HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO AND CHAIRMAN
Authorized Official - Prefix:PROF
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DABNEY
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP, MBA, MS
Authorized Official - Phone:917-618-4042
Mailing Address - Street 1:845 W 69TH STREET
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-1709
Mailing Address - Country:US
Mailing Address - Phone:917-618-4042
Mailing Address - Fax:
Practice Address - Street 1:845 W 69TH STREET
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-1709
Practice Address - Country:US
Practice Address - Phone:917-618-4042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty