Healthcare Provider Details

I. General information

NPI: 1326641069
Provider Name (Legal Business Name): EPIPHANY MENTAL HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 WASHINGTON ST STE LL6
BRAINTREE MA
02184-4772
US

IV. Provider business mailing address

420 WASHINGTON ST STE LL6
BRAINTREE MA
02184-4772
US

V. Phone/Fax

Practice location:
  • Phone: 781-985-0210
  • Fax:
Mailing address:
  • Phone: 781-985-0210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: NADIA VALENTIN
Title or Position: MANAGING PARTNER
Credential: DNP
Phone: 781-985-0210