Healthcare Provider Details

I. General information

NPI: 1427973445
Provider Name (Legal Business Name): VIDA PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CUMMINGS CTR STE 6500
BEVERLY MA
01915-6234
US

IV. Provider business mailing address

500 CUMMINGS CTR STE 6500
BEVERLY MA
01915-6234
US

V. Phone/Fax

Practice location:
  • Phone: 954-600-4150
  • Fax:
Mailing address:
  • Phone: 954-600-4150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA PENA
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: PMHNP
Phone: 781-650-4459