Provider Demographics
NPI:1952898330
Name:NEW BEGINNINGS REENTRY SERVICES, INC.
Entity Type:Organization
Organization Name:NEW BEGINNINGS REENTRY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/SUD COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LADC I 14960
Authorized Official - Phone:857-237-2780
Mailing Address - Street 1:22 DRYDOCK AVE OFC 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02210-2386
Mailing Address - Country:US
Mailing Address - Phone:857-237-2780
Mailing Address - Fax:617-507-6176
Practice Address - Street 1:22 DRYDOCK AVE OFC 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02210-2386
Practice Address - Country:US
Practice Address - Phone:857-237-2780
Practice Address - Fax:617-507-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14960101YA0400X, 251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA=========OtherMASS HEALTH INSURANCE