Healthcare Provider Details

I. General information

NPI: 1053185272
Provider Name (Legal Business Name): INTEGRATED BEHAVIORAL CARE NEW ENGLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 TURNPIKE ST STE 300
NORTH ANDOVER MA
01845-6156
US

IV. Provider business mailing address

431 JOHNSON ST
NORTH ANDOVER MA
01845-4721
US

V. Phone/Fax

Practice location:
  • Phone: 978-296-5595
  • Fax: 978-296-5594
Mailing address:
  • Phone: 978-886-2359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MEETING MOUZAKIS
Title or Position: EXECUTIVE DIRECTOR
Credential: LICSW, LEP
Phone: 978-886-2359