MEDICARE: BEAUTIFUL MIND PSYCHIATRIC MENTAL HEALTH SERVICES, 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
1	251S00000X	Community/Behavioral Health Agency	RN270513	MA

General Provider Information

NPI Number	:	1780128835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUTIFUL MIND PSYCHIATRIC MENTAL HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	99 DERBY ST
Second Line	:	SUITE 200, OFFICE 213
City	:	HINGHAM
State	:	MA
Zip	:	02043-4216
Country	:	US
Telephone Number	:	781-556-1013
Fax Number	:	781-885-0397

Provider Business Practice Location Address
First Line	:	99 DERBY ST
Second Line	:	SUITE 200, OFFICE 213
City	:	HINGHAM
State	:	MA
Zip	:	02043-4216
Country	:	US
Telephone Number	:	781-556-1013
Fax Number	:	781-885-0397

Authorized Official
Title or Position	:	NURSE PRACTITIONER/ENTREPRENEUR
Name	:	MURIANA JEANNITON
Credential	:	PMHNP-BC
Telephone Number	:	781-540-8541

Provider Enumeration Date	:	12/08/2016
Last Update Date	:	12/08/2016

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