Provider Demographics
NPI:1780128835
Name:BEAUTIFUL MIND PSYCHIATRIC MENTAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:BEAUTIFUL MIND PSYCHIATRIC MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/ENTREPRENEUR
Authorized Official - Prefix:
Authorized Official - First Name:MURIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEANNITON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:781-540-8541
Mailing Address - Street 1:99 DERBY ST
Mailing Address - Street 2:SUITE 200, OFFICE 213
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4216
Mailing Address - Country:US
Mailing Address - Phone:781-556-1013
Mailing Address - Fax:781-885-0397
Practice Address - Street 1:99 DERBY ST
Practice Address - Street 2:SUITE 200, OFFICE 213
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4216
Practice Address - Country:US
Practice Address - Phone:781-556-1013
Practice Address - Fax:781-885-0397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN270513251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health