Provider Demographics
NPI:1952993438
Name:NORTHEAST SUBSTANCE ABUSE PROFESSIONALS, LLC
Entity Type:Organization
Organization Name:NORTHEAST SUBSTANCE ABUSE PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURROWS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCDP, SAP
Authorized Official - Phone:401-209-0902
Mailing Address - Street 1:411 SHANNOCK RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-4750
Mailing Address - Country:US
Mailing Address - Phone:401-209-0902
Mailing Address - Fax:
Practice Address - Street 1:411 SHANNOCK RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4750
Practice Address - Country:US
Practice Address - Phone:401-209-0902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-06
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty