Healthcare Provider Details

I. General information

NPI: 1053772426
Provider Name (Legal Business Name): NEURO BEHAVIORAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 MAIN ST STE 15
WALPOLE MA
02081-3753
US

IV. Provider business mailing address

420 MAIN ST SUITE 14
WALPOLE MA
02081-3753
US

V. Phone/Fax

Practice location:
  • Phone: 508-660-1666
  • Fax: 508-660-1667
Mailing address:
  • Phone: 508-660-1666
  • Fax: 508-660-1667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: YOUSEF ABOU-ALLABAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 508-660-1666