Provider Demographics
NPI:1750833349
Name:NORTHEAST BEHAVIORAL ASSOCIATES
Entity Type:Organization
Organization Name:NORTHEAST BEHAVIORAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MONITOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQULYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTULLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-799-4823
Mailing Address - Street 1:1 DRIFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1269
Mailing Address - Country:US
Mailing Address - Phone:781-799-4823
Mailing Address - Fax:
Practice Address - Street 1:1 DRIFTWOOD DR
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1269
Practice Address - Country:US
Practice Address - Phone:781-799-4823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-29
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health