Provider Demographics
NPI:1790137461
Name:NORTHEAST BEHAVIORAL ASSOCIATES
Entity Type:Organization
Organization Name:NORTHEAST BEHAVIORAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:401-681-4637
Mailing Address - Street 1:53 ROLENS DRIVE
Mailing Address - Street 2:APARTMENT A5
Mailing Address - City:KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02881-1746
Mailing Address - Country:US
Mailing Address - Phone:860-705-8049
Mailing Address - Fax:
Practice Address - Street 1:2348 POST ROAD
Practice Address - Street 2:SUITE 107
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:401-681-4675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty