Magnolia Behavioral Health Services PLLC
Nurse Practitioner, Psych/Mental Health in Randolph, MA. Organization (NPI-2).
NPI number1235995648
StatusActive
Last updated in NPPESJun 20, 2024
Details
- NPI
- 1235995648
- Entity type
- Organization (NPI-2)
- Legal business name
- Magnolia Behavioral Health Services PLLC
- Organization subpart
- No
- Enumeration date
- Feb 23, 2024
- Certification date
- Jun 20, 2024
- Last updated
- Jun 20, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | – | – | Yes |
Practice location
247 N Main St Ste 13Randolph, MA 02368-4172
Phone 617-435-4633
Mailing address
247 N Main St Ste 13Randolph, MA 02368-4172
Authorized official
Nirva Lafontant
Owner
6174354633
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