Provider Demographics
NPI:1316245632
Name:NORTHEAST PSYCHOLOGICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:NORTHEAST PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, PSYD,, HSPP
Authorized Official - Phone:260-676-2252
Mailing Address - Street 1:578 GEIGER DR
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:ROANOKE
Mailing Address - State:IN
Mailing Address - Zip Code:46783-8872
Mailing Address - Country:US
Mailing Address - Phone:260-676-2252
Mailing Address - Fax:260-676-2260
Practice Address - Street 1:578 GEIGER DR
Practice Address - Street 2:SUITE A-1
Practice Address - City:ROANOKE
Practice Address - State:IN
Practice Address - Zip Code:46783-8872
Practice Address - Country:US
Practice Address - Phone:260-676-2252
Practice Address - Fax:260-676-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042473A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty