1669884409 NPI number — COGNITIVE BEHAVIOR INSTITUTE, LLC

Table of content: DR. RYAN ANDREW MACKE M.D. (NPI 1215034913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669884409 NPI number — COGNITIVE BEHAVIOR INSTITUTE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COGNITIVE BEHAVIOR INSTITUTE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669884409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
168 SOUTHRIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANBERRY TWP
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16066-2404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-814-9708
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2009 MACKENZIE WAY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CRANBERRY TWP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16066-5332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-814-9708
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CARIDAD
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
FOUNDER / DIRECTOR
Authorized Official Telephone Number:
724-814-9708

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CW017308 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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