Provider Demographics
NPI:1417662438
Name:MOUNTAINVIEW MIND & MOOD LLC
Entity Type:Organization
Organization Name:MOUNTAINVIEW MIND & MOOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:GENNARO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARENGA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:757-478-7008
Mailing Address - Street 1:712 GLENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-7752
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:712 GLENBROOK DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:MD
Practice Address - Zip Code:21769-7752
Practice Address - Country:US
Practice Address - Phone:757-478-7008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty