Healthcare Provider Details

I. General information

NPI: 1154302586
Provider Name (Legal Business Name): NORTHEAST BEHAVIORAL HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CUMMINGS CENTER SUITE 266T
BEVERLY MA
01915-6172
US

IV. Provider business mailing address

41 MALL RD
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 978-921-1190
  • Fax: 978-927-3724
Mailing address:
  • Phone: 978-968-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number4770
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number0050372
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER CULLEN
Title or Position: PRESIDENT BEHAVIORAL HEALTH SERVICE
Credential:
Phone: 413-636-2391