Provider Demographics
NPI:1962619841
Name:INTERNET BEHAVIORAL CARE, PC
Entity type:Organization
Organization Name:INTERNET BEHAVIORAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-941-3348
Mailing Address - Street 1:4610 E STREET RD
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6612
Mailing Address - Country:US
Mailing Address - Phone:800-366-0129
Mailing Address - Fax:215-638-1299
Practice Address - Street 1:4610 E STREET RD
Practice Address - Street 2:
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6612
Practice Address - Country:US
Practice Address - Phone:800-366-0129
Practice Address - Fax:215-638-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Not Answered261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health