Healthcare Provider Details

I. General information

NPI: 1477492429
Provider Name (Legal Business Name): EXPANSIVE MIND INTEGRATIVE PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 KILSYTH RD APT 7
BRIGHTON MA
02135-7856
US

IV. Provider business mailing address

140 KILSYTH RD APT 7
BRIGHTON MA
02135-7856
US

V. Phone/Fax

Practice location:
  • Phone: 617-412-7071
  • Fax:
Mailing address:
  • Phone: 617-412-7071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. OLGA PAVLEYEVA
Title or Position: OWNER
Credential: CNP, PMHNP-BC
Phone: 617-412-7071