Provider Demographics
NPI:1295575413
Name:MINDGROVE HEALTH
Entity type:Organization
Organization Name:MINDGROVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FEYISETAN
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:RAMEY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP, APRN
Authorized Official - Phone:781-202-1565
Mailing Address - Street 1:20 CABOT BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1183
Mailing Address - Country:US
Mailing Address - Phone:781-202-1565
Mailing Address - Fax:781-202-1593
Practice Address - Street 1:20 CABOT BLVD STE 300
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1183
Practice Address - Country:US
Practice Address - Phone:781-202-1565
Practice Address - Fax:781-202-1593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-27
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty