Provider Demographics
NPI:1922133115
Name:NEUROBEHAVIORAL SERVICES OF NEW ENGLAND, PC
Entity Type:Organization
Organization Name:NEUROBEHAVIORAL SERVICES OF NEW ENGLAND, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-662-8660
Mailing Address - Street 1:335 BRIGHTON AVENUE
Mailing Address - Street 2:UNIT 201
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2374
Mailing Address - Country:US
Mailing Address - Phone:207-662-8660
Mailing Address - Fax:207-662-8492
Practice Address - Street 1:335 BRIGHTON AVENUE
Practice Address - Street 2:UNIT 201
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2374
Practice Address - Country:US
Practice Address - Phone:207-662-8660
Practice Address - Fax:207-662-8492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME154880000Medicaid
MEMM7189Medicare ID - Type Unspecified