Provider Demographics
NPI:1922726173
Name:ADVANCED MENTAL HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:ADVANCED MENTAL HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MACNEIL
Authorized Official - Suffix:
Authorized Official - Credentials:PMNNP-BC
Authorized Official - Phone:978-255-4871
Mailing Address - Street 1:42 PLEASANT ST UNIT 6A
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2606
Mailing Address - Country:US
Mailing Address - Phone:978-255-4871
Mailing Address - Fax:
Practice Address - Street 1:42 PLEASANT ST UNIT 6A
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2606
Practice Address - Country:US
Practice Address - Phone:978-255-4871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1780979757OtherNPI