Square Behavioral Health, LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

SQUARE BEHAVIORAL HEALTH, LLC

Practice address

733 Turnpike St # 162
North Andover, MA 01845-6137

Phone

(781) 771-8242

NPI assigned

Oct 6, 2020

Organization subpart

No

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

Authorized official

Name

Arinze P Ejiofor, PMHNPNPI 1699236034

Title

President

Phone

(781) 771-8242

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Locations

Practitioners 3

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

• Arinze P Ejiofor

  • Psychiatric/Mental Health Nurse Practitioner
  • North Andover, MA
  • NPI 1699236034
  Medicare reassignment Care Compare group NPD Authorized official
• Evie P Chase, LICSW

  • Clinical Social Worker
  • Lowell, MA
  • NPI 1821449166
  Medicare reassignment Care Compare group NPD
• Jacqueline Mosselle, MSW

  • Social Worker
  • Lowell, MA
  • NPI 1679996250
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1601942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601942400000",
    "number": "1699372235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "733 TURNPIKE ST # 162",
            "city": "NORTH ANDOVER",
            "state": "MA",
            "postal_code": "018456137",
            "telephone_number": "781-771-8242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "733 TURNPIKE ST # 162",
            "city": "NORTH ANDOVER",
            "state": "MA",
            "postal_code": "018456137",
            "telephone_number": "781-771-8242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SQUARE BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-06",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A",
        "authorized_official_last_name": "EJIOFOR",
        "authorized_official_first_name": "ARINZE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-771-8242",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in North Andover, MA
• Providers in North Andover, MA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.