NPIMap

Organization Active NPI

Northeastern Behavioral Health, PC

  • Adult Mental Health Clinic/Center
  • Milford, PA
National Provider Identifier
1215568431
Registry record updated Jan 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
NORTHEASTERN BEHAVIORAL HEALTH, PC
Practice address
140 Bennett Avenue
Suite 1B
Milford, PA 18337
Phone
(570) 832-4339
NPI assigned
Jan 27, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly Kowalik, LPC, CAADCNPI 1710396221
Title
Chief Executive Officer
Phone
(570) 832-4339

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

140 Bennett Avenue
Suite 1B
Milford, PA 18337

Mailing address

140 Bennett Avenue
Suite 1B
Milford, PA 18338
Phone (570) 832-4339

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580083200000",
    "number": "1215568431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 BENNETT AVENUE",
            "address_2": "SUITE 1B",
            "city": "MILFORD",
            "state": "PA",
            "postal_code": "18338",
            "telephone_number": "570-832-4339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 BENNETT AVENUE",
            "address_2": "SUITE 1B",
            "city": "MILFORD",
            "state": "PA",
            "postal_code": "18337",
            "telephone_number": "570-832-4339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN BEHAVIORAL HEALTH, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-27",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A",
        "authorized_official_last_name": "KOWALIK",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "570-832-4339",
        "authorized_official_credential": "LPC, CAADC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milford, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.