Provider Demographics
NPI:1871838474
Name:NORTHEAST BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:NORTHEAST BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:N
Authorized Official - Last Name:SZENBORN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPCC
Authorized Official - Phone:330-533-3102
Mailing Address - Street 1:3821 STARRS CENTRE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8003
Mailing Address - Country:US
Mailing Address - Phone:330-533-3102
Mailing Address - Fax:330-533-3123
Practice Address - Street 1:3821 STARRS CENTRE DR
Practice Address - Street 2:SUITE B
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8003
Practice Address - Country:US
Practice Address - Phone:330-533-3102
Practice Address - Fax:330-533-3123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1100401101YP2500X
OHI.11015981041C0700X
OHI.00083401041C0700X
OH35.0410102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty