Provider Demographics
NPI:1558545491
Name:NORTHEASTPSYCHOTHERAPY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NORTHEASTPSYCHOTHERAPY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:H
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:860-230-0771
Mailing Address - Street 1:50 ACADEMY HILL RD
Mailing Address - Street 2:UNIT D
Mailing Address - City:PLAINFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06374-1600
Mailing Address - Country:US
Mailing Address - Phone:860-230-0771
Mailing Address - Fax:
Practice Address - Street 1:50 ACADEMY HILL RD
Practice Address - Street 2:UNIT D
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374-1600
Practice Address - Country:US
Practice Address - Phone:860-230-0771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0006121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty