Provider Demographics
NPI:1669201646
Name:BEHAVIORAL & MENTAL HEALTH ANN DESL
Entity type:Organization
Organization Name:BEHAVIORAL & MENTAL HEALTH ANN DESL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DESLOGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-463-5007
Mailing Address - Street 1:39 ESSEX GREEN LN
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2919
Mailing Address - Country:US
Mailing Address - Phone:781-463-5007
Mailing Address - Fax:
Practice Address - Street 1:40 LOWELL ST STE 14
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-5400
Practice Address - Country:US
Practice Address - Phone:781-463-5007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty