Provider Demographics
NPI:1629754866
Name:MPL WELLNESS NP IN PSYCHIATRY
Entity Type:Organization
Organization Name:MPL WELLNESS NP IN PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:P
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:518-316-7177
Mailing Address - Street 1:PO BOX 704
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-0704
Mailing Address - Country:US
Mailing Address - Phone:518-316-7177
Mailing Address - Fax:518-801-1596
Practice Address - Street 1:952 TROY SCHENECTADY RD STE 111
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1622
Practice Address - Country:US
Practice Address - Phone:518-316-7177
Practice Address - Fax:518-801-1596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-23
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)