1922726173 NPI number — ADVANCED MENTAL HEALTH AND WELLNESS

Table of content: (NPI 1922726173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922726173 NPI number — ADVANCED MENTAL HEALTH AND WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED MENTAL HEALTH AND WELLNESS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922726173
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42 PLEASANT ST UNIT 6A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWBURYPORT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01950-2606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-255-4871
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42 PLEASANT ST UNIT 6A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURYPORT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01950-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-255-4871
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2022

Additional Information

Authorized Official

Authorized Official Last Name:
MACNEIL
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
978-255-4871

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1780979757 . This is a "NPI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com