Provider Demographics
NPI:1679249882
Name:COTTAGE PSYCHIATRY LLC
Entity Type:Organization
Organization Name:COTTAGE PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPONE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:781-300-8916
Mailing Address - Street 1:8 CEDAR PARK RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2548
Mailing Address - Country:US
Mailing Address - Phone:781-300-8916
Mailing Address - Fax:
Practice Address - Street 1:8 CEDAR PARK RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-2548
Practice Address - Country:US
Practice Address - Phone:781-300-8916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1225497076Medicaid