Provider Demographics
NPI:1356179089
Name:CLEVELAND BEHAVIORAL HEALTHCARE LLC
Entity type:Organization
Organization Name:CLEVELAND BEHAVIORAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLEVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-807-9819
Mailing Address - Street 1:11 SADDLEGATE LN
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4579
Mailing Address - Country:US
Mailing Address - Phone:207-807-9819
Mailing Address - Fax:866-635-1146
Practice Address - Street 1:11 SADDLEGATE LN
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4579
Practice Address - Country:US
Practice Address - Phone:207-807-9819
Practice Address - Fax:866-635-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty