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NPI Code Detail

MEDICARE: MENDED MINDS MENTAL HEALTH LLC

MEDICARE: MENDED MINDS MENTAL HEALTH LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1508706300
Entity Type Code : Organization
Provider Name (Legal Business Name) : MENDED MINDS MENTAL HEALTH LLC
Provider Business Mailing Address
First Line : 31 PINE KNOLL RD
Second Line :
City : LEXINGTON
State : MA
Zip : 02420-1206
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 57 BEDFORD ST STE 230
Second Line :
City : LEXINGTON
State : MA
Zip : 02420-4502
Country : US
Telephone Number : 617-213-0435
Fax Number :
Authorized Official
Title or Position : CLINICAL PSYCHOLOGIST
Name : DR. DEVIN MASSARO
Credential : PH.D.
Telephone Number : 609-707-0065
Provider Enumeration Date : 03/31/2026
Last Update Date : 03/31/2026

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Directions to “MENDED MINDS MENTAL HEALTH LLC ” Practice Location

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