Healthcare Provider Details

I. General information

NPI: 1275100547
Provider Name (Legal Business Name): NORTHEAST FAMILY SERVICES OF FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N LAKE DESTINY RD
MAITLAND FL
32751-7114
US

IV. Provider business mailing address

354 MERRIMACK ST # 395
LAWRENCE MA
01843-1754
US

V. Phone/Fax

Practice location:
  • Phone: 978-807-3377
  • Fax:
Mailing address:
  • Phone: 978-807-3377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: NIDHI TURNER
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 978-530-6605