Provider Demographics
NPI:1619571056
Name:MERRIMACK BEHAVIORAL PARTNERS LLC
Entity Type:Organization
Organization Name:MERRIMACK BEHAVIORAL PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WAWERU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-335-4690
Mailing Address - Street 1:181 CROSBY STREET EXT
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-2207
Mailing Address - Country:US
Mailing Address - Phone:978-268-2788
Mailing Address - Fax:
Practice Address - Street 1:181 CROSBY STREET EXT
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-2207
Practice Address - Country:US
Practice Address - Phone:978-268-2788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty