Provider Demographics
NPI:1467635326
Name:NORTHEAST CENTER FOR YOUTH AND FAMILIES
Entity Type:Organization
Organization Name:NORTHEAST CENTER FOR YOUTH AND FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JACQUELINE
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CAGS
Authorized Official - Phone:413-575-9095
Mailing Address - Street 1:1556 STORRS RD.
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06268
Mailing Address - Country:US
Mailing Address - Phone:860-487-4846
Mailing Address - Fax:860-487-4847
Practice Address - Street 1:1556 STORRS RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06028
Practice Address - Country:US
Practice Address - Phone:860-487-4846
Practice Address - Fax:869-487-4847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children