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General NPI Number Information
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NPI Number | 1134462310
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Entity Type | Organization
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Legal Business Name | NORTHEAST BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 04/05/2013
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Last Update Date | 04/05/2013
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Provider Practice Location Address
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Address Line | 41 MASON ST 4
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City | SALEM
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State | MA
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Zip | 01970-2260
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Country | US
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Telephone | 734-834-0324
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Fax |
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Provider Business Mailing Address
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Address Line | 41 MASON ST. 4
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City | SALEM
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State | MA
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Zip | 01970
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Country | US
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Telephone | 734-834-0324
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Fax |
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Authorized Official
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Title or Position | EMERGENCY SERVICES CLINICIAN
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Name | MS. JENNIFER IRENE FREIDEL
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Credential | L.C.S.W.
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Telephone | 734-834-0324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 217242
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License Number State | MA
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