Provider Demographics
NPI:1851629497
Name:NORTHEAST BEHAVIORAL ASSOCIATES OF CT. INC.
Entity Type:Organization
Organization Name:NORTHEAST BEHAVIORAL ASSOCIATES OF CT. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATCH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-754-7735
Mailing Address - Street 1:68 HEBRON AVE
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-7241
Mailing Address - Country:US
Mailing Address - Phone:781-929-0553
Mailing Address - Fax:
Practice Address - Street 1:769 NEWFIELD ST STE 5
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-1846
Practice Address - Country:US
Practice Address - Phone:860-754-7735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-01-0652103K00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty