Provider Demographics
NPI:1730525163
Name:NORTHEAST HEALTH SERVICES
Entity type:Organization
Organization Name:NORTHEAST HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-880-6666
Mailing Address - Street 1:30 TAUNTON GRN
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3243
Mailing Address - Country:US
Mailing Address - Phone:508-880-6666
Mailing Address - Fax:508-880-6655
Practice Address - Street 1:30 TAUNTON GRN
Practice Address - Street 2:SUITE 5
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3243
Practice Address - Country:US
Practice Address - Phone:508-880-6666
Practice Address - Fax:508-880-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health