Provider Demographics
NPI:1720494388
Name:NEW ENGLAND INSTITUTE OF DEVELOPMENTAL PEDIATRICS
Entity Type:Organization
Organization Name:NEW ENGLAND INSTITUTE OF DEVELOPMENTAL PEDIATRICS
Other - Org Name:ADAM'S CAMP NEW ENGLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:FERRO
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-715-2298
Mailing Address - Street 1:26 SHAKER RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-6924
Mailing Address - Country:US
Mailing Address - Phone:603-715-2298
Mailing Address - Fax:
Practice Address - Street 1:26 SHAKER RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-6924
Practice Address - Country:US
Practice Address - Phone:603-715-2298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADAM'S CAMP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty