Northeast Behavioral Medicine Inc.

Primary specialty

Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X

Legal business name

NORTHEAST BEHAVIORAL MEDICINE INC.

Practice address

6800 Castor Ave
Suite D
Philadelphia, PA 19149-2100

Phone

(215) 904-8748

Fax

(215) 904-8691

NPI assigned

Aug 27, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Rick F Nelson Jr.

Title

Provider Relations

Phone

(215) 904-8748

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1251331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277164800000",
    "number": "1346473196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 CASTOR AVE",
            "address_2": "SUITE D",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191492100",
            "telephone_number": "215-904-8748",
            "fax_number": "215-904-6891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6800 CASTOR AVE",
            "address_2": "SUITE D",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191492100",
            "telephone_number": "215-904-8748",
            "fax_number": "215-904-8691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST BEHAVIORAL MEDICINE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-27",
        "last_updated": "2010-06-22",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "RICK",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PROVIDER RELATIONS",
        "authorized_official_telephone_number": "215-904-8748",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Psychologist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Addiction (Substance Use Disorder) Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2010; 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.