Provider Demographics
NPI:1346473196
Name:NORTHEAST BEHAVIORAL MEDICINE INC.
Entity Type:Organization
Organization Name:NORTHEAST BEHAVIORAL MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:F
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:215-904-8748
Mailing Address - Street 1:6800 CASTOR AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-2100
Mailing Address - Country:US
Mailing Address - Phone:215-904-8748
Mailing Address - Fax:215-904-6891
Practice Address - Street 1:6800 CASTOR AVE
Practice Address - Street 2:SUITE D
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2100
Practice Address - Country:US
Practice Address - Phone:215-904-8748
Practice Address - Fax:215-904-8691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty