Provider Demographics
NPI:1063802098
Name:NEW ENGLAND BEHAVIOR SPECIALTY PLLC
Entity type:Organization
Organization Name:NEW ENGLAND BEHAVIOR SPECIALTY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNESSEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CPNP
Authorized Official - Phone:978-577-0437
Mailing Address - Street 1:119 RUSSELL ST
Mailing Address - Street 2:SUITE 30
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-1274
Mailing Address - Country:US
Mailing Address - Phone:978-679-1200
Mailing Address - Fax:978-486-4037
Practice Address - Street 1:119 RUSSELL ST
Practice Address - Street 2:SUITE 30
Practice Address - City:LITTLETON
Practice Address - State:MA
Practice Address - Zip Code:01460-1274
Practice Address - Country:US
Practice Address - Phone:978-679-1200
Practice Address - Fax:978-486-4037
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW ENGLAND CENTER FOR MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty