Healthcare Provider Details

I. General information

NPI: 1740601400
Provider Name (Legal Business Name): NORTHEAST CENTER FOR YOUTH AND FAMILIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2013
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 EAST ST
EASTHAMPTON MA
01027-1234
US

IV. Provider business mailing address

201 EAST ST
EASTHAMPTON MA
01027-1234
US

V. Phone/Fax

Practice location:
  • Phone: 413-529-7777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number218632
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MEREDITH LAGOY
Title or Position: ASSOCIATE EXECUTIVE DIRECTOR
Credential: LICSW
Phone: 413-529-7777