| Active Behavioral Group, Llc | |
|
13242 Hunters Breeze St San Antonio TX 78230-2867 | |
| (347) 927-4409 | |
| Not Available |
| Full Name | Active Behavioral Group, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 13242 Hunters Breeze St, San Antonio, Texas |
| Authorized Official Name and Position | Leonid Royzman (CLINICIAN) |
| Authorized Official Contact | 3479274409 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Active Behavioral Group, Llc 13242 Hunters Breeze St San Antonio TX 78230-2867 Ph: (347) 927-4409 | Active Behavioral Group, Llc 13242 Hunters Breeze St San Antonio TX 78230-2867 Ph: (347) 927-4409 |
| NPI Number | 1174232797 |
|---|---|
| Provider Enumeration Date | 11/22/2022 |
| Last Update Date | 11/22/2022 |
| Certification Date | 11/22/2022 |
| Medicare PECOS PAC ID | 7810369279 |
|---|---|
| Medicare Enrollment ID | O20230211000224 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174232797 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Leonid Royzman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700100435 PECOS PAC ID: 6204238769 Enrollment ID: I20210707001940 |
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