Provider Demographics
NPI:1982967741
Name:NORTHEAST BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:NORTHEAST BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-620-1250
Mailing Address - Street 1:12 METHUEN ST
Mailing Address - Street 2:#2
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1700
Mailing Address - Country:US
Mailing Address - Phone:978-620-1250
Mailing Address - Fax:978-682-9333
Practice Address - Street 1:12 METHUEN ST
Practice Address - Street 2:#2
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1700
Practice Address - Country:US
Practice Address - Phone:978-620-1250
Practice Address - Fax:978-682-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health