Healthcare Provider Details

I. General information

NPI: 1396656070
Provider Name (Legal Business Name): DESIGNED TO BE DIFFERENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 ELLIOT ST
BROCKTON MA
02302-2356
US

IV. Provider business mailing address

172 ELLIOT ST
BROCKTON MA
02302-2356
US

V. Phone/Fax

Practice location:
  • Phone: 508-649-9832
  • Fax:
Mailing address:
  • Phone: 508-649-9832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISMANIE SAINTLOTH
Title or Position: CEO
Credential: PMHNP
Phone: 508-649-9832