Provider Demographics
NPI:1174214365
Name:PROSOCIAL BEHAVIORAL HEALTH INCORPORATED
Entity type:Organization
Organization Name:PROSOCIAL BEHAVIORAL HEALTH INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:SHERWIN
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:904-673-0684
Mailing Address - Street 1:1216 SUMMIT OAKS DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-3236
Mailing Address - Country:US
Mailing Address - Phone:904-673-0684
Mailing Address - Fax:
Practice Address - Street 1:1216 SUMMIT OAKS DR W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-3236
Practice Address - Country:US
Practice Address - Phone:904-673-0684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty