Provider Demographics
NPI:1912431420
Name:CSI- BEHAVIORAL SERVICES, INC.
Entity Type:Organization
Organization Name:CSI- BEHAVIORAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SODERQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-889-1269
Mailing Address - Street 1:10451 NW 117TH AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1116
Mailing Address - Country:US
Mailing Address - Phone:305-821-1262
Mailing Address - Fax:305-828-8614
Practice Address - Street 1:10451 NW 117TH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33178-1116
Practice Address - Country:US
Practice Address - Phone:305-821-1262
Practice Address - Fax:305-828-8614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty