Healthcare Provider Details

I. General information

NPI: 1659382315
Provider Name (Legal Business Name): NORTHEAST BEHAVIORAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SUTTON ST STE AND142
NORTH ANDOVER MA
01845-1656
US

IV. Provider business mailing address

2348 POST RD STE 107
WARWICK RI
02886-2271
US

V. Phone/Fax

Practice location:
  • Phone: 774-206-1125
  • Fax: 774-628-9657
Mailing address:
  • Phone: 401-808-6330
  • Fax: 401-808-6333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. PETER C. PATCH
Title or Position: EXECUTIVE DIRECTOR
Credential: PSY.D.
Phone: 401-808-6330