Provider Demographics
NPI:1083966642
Name:COMMUNITY BEHAVIORAL MANAGEMENT,INC
Entity type:Organization
Organization Name:COMMUNITY BEHAVIORAL MANAGEMENT,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TARGETED CASE MANAGER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIDICE
Authorized Official - Middle Name:GISEL
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:BS,FMD
Authorized Official - Phone:786-230-5396
Mailing Address - Street 1:9440 NW 35TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-2730
Mailing Address - Country:US
Mailing Address - Phone:786-230-5396
Mailing Address - Fax:786-431-1491
Practice Address - Street 1:3 SW 129TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1779
Practice Address - Country:US
Practice Address - Phone:786-230-5396
Practice Address - Fax:786-431-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-07
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty