Basic Information
| Provider Information | |||||||||
| NPI: | 1730525163 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHEAST HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 TAUNTON GRN | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | TAUNTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027803243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088806666 | ||||||||
| FaxNumber: | 5088806655 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 TAUNTON GRN | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | TAUNTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027803243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088806666 | ||||||||
| FaxNumber: | 5088806655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2013 | ||||||||
| LastUpdateDate: | 05/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | BRENNAN | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | KARL | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CLINICAL OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 5088806666 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LICSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | MA | N | Agencies | Community/Behavioral Health | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.