Provider Demographics
NPI:1104288505
Name:NORTHEAST BEHAVIORAL ASSOCIATES
Entity type:Organization
Organization Name:NORTHEAST BEHAVIORAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL MANAGEMENT MONITOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WRIGHT SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-206-1125
Mailing Address - Street 1:145 FAUNCE CORNER ROAD ,SUITE K
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTHMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:285 BRAINERD STREET
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075
Practice Address - Country:US
Practice Address - Phone:413-534-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health