Provider Demographics
NPI:1720397284
Name:NORTHEAST BEHAVIORAL ASSOCIATES
Entity Type:Organization
Organization Name:NORTHEAST BEHAVIORAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:PATCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-681-4637
Mailing Address - Street 1:2348 POST RD STE 107
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2271
Mailing Address - Country:US
Mailing Address - Phone:401-681-4637
Mailing Address - Fax:
Practice Address - Street 1:2348 POST RD STE 107
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2271
Practice Address - Country:US
Practice Address - Phone:401-681-4637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-08-2523103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty