Healthcare Provider Details

I. General information

NPI: 1992095798
Provider Name (Legal Business Name): WAYNE ETHIER MSN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 LIBERTY SQ STE 91536
BOSTON MA
02109-5800
US

IV. Provider business mailing address

6 LIBERTY SQ STE 91536
BOSTON MA
02109-5800
US

V. Phone/Fax

Practice location:
  • Phone: 508-422-0404
  • Fax: 857-578-1200
Mailing address:
  • Phone: 508-422-0404
  • Fax: 857-578-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2314626
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: