Provider Demographics
NPI:1427290170
Name:NORTHEAST BEHAVIORAL ASSOCIATES
Entity type:Organization
Organization Name:NORTHEAST BEHAVIORAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATCH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:401-808-6330
Mailing Address - Street 1:744 PARK AVE
Mailing Address - Street 2:SUITE NUMBER 6
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-2150
Mailing Address - Country:US
Mailing Address - Phone:401-808-6330
Mailing Address - Fax:401-808-6333
Practice Address - Street 1:744 PARK AVE
Practice Address - Street 2:SUITE NUMBER 6
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-2150
Practice Address - Country:US
Practice Address - Phone:401-808-6330
Practice Address - Fax:401-808-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
RINB65361Medicaid