Provider Demographics
NPI:1134462310
Name:NORTHEAST BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:NORTHEAST BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMERGENCY SERVICES CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:FREIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:734-834-0324
Mailing Address - Street 1:41 MASON ST.
Mailing Address - Street 2:4
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:734-834-0324
Mailing Address - Fax:
Practice Address - Street 1:41 MASON ST
Practice Address - Street 2:4
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2260
Practice Address - Country:US
Practice Address - Phone:734-834-0324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2172421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty