Provider Demographics
NPI:1396420311
Name:NEWBURYPORT MENTAL HEALTH, PLLC
Entity type:Organization
Organization Name:NEWBURYPORT MENTAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KAI
Authorized Official - Middle Name:
Authorized Official - Last Name:NICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-838-8521
Mailing Address - Street 1:295 WHIPPLE RD
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-3535
Mailing Address - Country:US
Mailing Address - Phone:207-838-8521
Mailing Address - Fax:
Practice Address - Street 1:8 ESSEX CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2964
Practice Address - Country:US
Practice Address - Phone:207-838-8521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty