Provider Demographics
NPI:1295601060
Name:RESTORED NEUROBEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:RESTORED NEUROBEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KISSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-304-0052
Mailing Address - Street 1:617 MILL ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-1775
Mailing Address - Country:US
Mailing Address - Phone:508-688-5602
Mailing Address - Fax:
Practice Address - Street 1:617 MILL ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-1775
Practice Address - Country:US
Practice Address - Phone:508-688-5602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-16
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health