Provider Demographics
NPI:1699372235
Name:SQUARE BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:SQUARE BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARINZE
Authorized Official - Middle Name:P
Authorized Official - Last Name:EJIOFOR
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:781-771-8242
Mailing Address - Street 1:733 TURNPIKE ST # 162
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6137
Mailing Address - Country:US
Mailing Address - Phone:781-771-8242
Mailing Address - Fax:
Practice Address - Street 1:733 TURNPIKE ST # 162
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-6137
Practice Address - Country:US
Practice Address - Phone:781-771-8242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty