Provider Demographics
NPI:1154528867
Name:PRIMECARE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:PRIMECARE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-686-6891
Mailing Address - Street 1:297 KNOLLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1833
Mailing Address - Country:US
Mailing Address - Phone:914-686-6891
Mailing Address - Fax:914-682-7518
Practice Address - Street 1:297 KNOLLWOOD RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1833
Practice Address - Country:US
Practice Address - Phone:914-686-6891
Practice Address - Fax:914-682-7518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013089-1103T00000X
NY014915-1103T00000X
NYR022413-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty