Healthcare Provider Details
I. General information
NPI: 1497672729
Provider Name (Legal Business Name): MALACHI BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
12 MCINTYRE RD
CHARLTON MA
01507-5124
US
IV. Provider business mailing address
12 MCINTYRE RD
CHARLTON MA
01507-5124
US
V. Phone/Fax
- Phone: 774-922-2350
- Fax:
- Phone: 774-922-2350
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
AMMA
ASARE
Title or Position: NP
Credential: PMHNP
Phone: 774-922-2350