Basic Information
| Provider Information | |||||||||
| NPI: | 1063802098 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW ENGLAND BEHAVIOR SPECIALTY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 119 RUSSELL ST | ||||||||
| Address2: | SUITE 30 | ||||||||
| City: | LITTLETON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014601274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786791200 | ||||||||
| FaxNumber: | 9784864037 | ||||||||
| Practice Location | |||||||||
| Address1: | 119 RUSSELL ST | ||||||||
| Address2: | SUITE 30 | ||||||||
| City: | LITTLETON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014601274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786791200 | ||||||||
| FaxNumber: | 9784864037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2015 | ||||||||
| LastUpdateDate: | 01/29/2015 | ||||||||
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| AuthorizedOfficialLastName: | HENNESSEY | ||||||||
| AuthorizedOfficialFirstName: | JESSICA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 9785770437 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NEW ENGLAND CENTER FOR MENTAL HEALTH | ||||||||
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| AuthorizedOfficialCredential: | RN, CPNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0804X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.