Provider Demographics
NPI:1720344120
Name:COORDINATED BEHAVIORAL CARE, INC
Entity Type:Organization
Organization Name:COORDINATED BEHAVIORAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PETIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-930-8803
Mailing Address - Street 1:123 WILLIAM STREET
Mailing Address - Street 2:19TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038
Mailing Address - Country:US
Mailing Address - Phone:646-930-8803
Mailing Address - Fax:212-619-7275
Practice Address - Street 1:40 RECTOR ST
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1705
Practice Address - Country:US
Practice Address - Phone:212-385-3030
Practice Address - Fax:212-619-7275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization