Healthcare Provider Details

I. General information

NPI: 1801522933
Provider Name (Legal Business Name): MELLOMINDS PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 BEACON ST FL 6
BOSTON MA
02116-1236
US

IV. Provider business mailing address

PO BOX 600789
NEWTONVILLE MA
02460-0007
US

V. Phone/Fax

Practice location:
  • Phone: 617-221-6547
  • Fax: 619-326-3953
Mailing address:
  • Phone: 617-221-6547
  • Fax: 619-326-3953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW MELARAGNO
Title or Position: OWNER
Credential: MD
Phone: 617-221-6547