Provider Demographics
NPI:1346560083
Name:NEW ENGLAND CENTER FOR MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:NEW ENGLAND CENTER FOR MENTAL HEALTH LLC
Other - Org Name:NEW ENGLAND CENTER FOR MENTAL HEALTHY MINDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADHAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMIREDDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-679-1200
Mailing Address - Street 1:289 GREAT ROAD
Mailing Address - Street 2:SUITE G1
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720
Mailing Address - Country:US
Mailing Address - Phone:978-679-1200
Mailing Address - Fax:978-486-4037
Practice Address - Street 1:289 GREAT ROAD
Practice Address - Street 2:SUITE G1
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720
Practice Address - Country:US
Practice Address - Phone:978-679-1200
Practice Address - Fax:978-486-4037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA020860Medicaid