Healthcare Provider Details

I. General information

NPI: 1457806804
Provider Name (Legal Business Name): NORTHEAST CLINICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ORDWAY ST
GEORGETOWN MA
01833-1225
US

IV. Provider business mailing address

7 ORDWAY ST
GEORGETOWN MA
01833-1225
US

V. Phone/Fax

Practice location:
  • Phone: 978-420-7151
  • Fax:
Mailing address:
  • Phone: 978-420-7151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3253
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number105
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number845
License Number StateMA

VIII. Authorized Official

Name: DON MARTEL
Title or Position: PRINCIPAL
Credential:
Phone: 978-420-7151