Provider Demographics
NPI:1508042003
Name:NEW LEAF BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:NEW LEAF BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAVA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSERALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-781-8370
Mailing Address - Street 1:3725 NATIONAL DRIVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4879
Mailing Address - Country:US
Mailing Address - Phone:919-781-8370
Mailing Address - Fax:919-781-2266
Practice Address - Street 1:3725 NATIONAL DR
Practice Address - Street 2:SUITE 220
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4066
Practice Address - Country:US
Practice Address - Phone:919-781-8370
Practice Address - Fax:919-781-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable