Healthcare Provider Details

I. General information

NPI: 1942814264
Provider Name (Legal Business Name): NORTHEAST FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 LINCOLN ST
WORCESTER MA
01605-3646
US

IV. Provider business mailing address

280 MERRIMACK ST STE 312
LAWRENCE MA
01843-1779
US

V. Phone/Fax

Practice location:
  • Phone: 774-320-0361
  • Fax: 774-628-9657
Mailing address:
  • Phone: 774-206-1125
  • Fax: 774-628-9657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: FRANCELYS DESARDEN FLORES
Title or Position: IN HOME THERAPIST CLINICIAN
Credential: MS
Phone: 787-341-0989