Healthcare Provider Details

I. General information

NPI: 1679362958
Provider Name (Legal Business Name): LUCY W WAHINYA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2025
Last Update Date: 09/11/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 DUNHAM RDG RD SUITE 3200-3350
BEVERLY MA
01915
US

IV. Provider business mailing address

40 MYSTIC ST
METHUEN MA
01844-2417
US

V. Phone/Fax

Practice location:
  • Phone: 978-600-0816
  • Fax: 978-600-2047
Mailing address:
  • Phone: 978-390-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2025003819
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: