NPIMap

Organization Active NPI

Northeast Behavioral Health LLC

  • Psychiatry Physician
  • Canfield, OH
National Provider Identifier
1871838474
Registry record updated Mar 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
35.041010 Issued in OH
Legal business name
NORTHEAST BEHAVIORAL HEALTH LLC
Practice address
3821 Starrs Centre Dr
Suite B
Canfield, OH 44406-8003
Phone
(330) 533-3102
Fax
(330) 533-3123
NPI assigned
Dec 7, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2016

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

Authorized official

Name
Mrs. Jessica N Szenborn, MS, LPCCNPI 1730588286
Title
Owner
Phone
(330) 533-3102

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X C.1100401 OH
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X I.1101598 OH
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X I.0008340 OH
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 35.041010 OH Primary

Addresses

Primary practice location

3821 Starrs Centre Dr
Suite B
Canfield, OH 44406-8003

Mailing address

3821 Starrs Centre Dr
Suite B
Canfield, OH 44406-8003
Phone (330) 533-3102

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131106001580 OH Part B Supplier - Clinic/Group Practice 9234364878 Receives reassigned benefits from 4 practitioners
Practice locations: Canfield, OH

National Provider Directory

National Provider Directory

Locations

3821 Starrs Centre Dr
#B
Canfield, OH 44406
Phone (330) 533-1134

3660 Starrs Centre Dr
Ste 3
Canfield, OH 44406
Phone (330) 533-1315

Practitioners & affiliated clinicians

Practitioners 5

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": "1354838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459123200000",
    "number": "1871838474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3821 STARRS CENTRE DR",
            "address_2": "SUITE B",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444068003",
            "telephone_number": "330-533-3102",
            "fax_number": "330-533-3123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3821 STARRS CENTRE DR",
            "address_2": "SUITE B",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444068003",
            "telephone_number": "330-533-3102",
            "fax_number": "330-533-3123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-07",
        "last_updated": "2016-03-28",
        "status": "A",
        "authorized_official_last_name": "SZENBORN",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-533-3102",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS, LPCC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "C.1100401",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.1101598",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.0008340",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OH",
            "license": "35.041010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canfield, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2016; 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.