Healthcare Provider Details

I. General information

NPI: 1831942432
Provider Name (Legal Business Name): NEW HEALING PATHWAYS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 JUNCTION SQUARE DR
CONCORD MA
01742-3049
US

IV. Provider business mailing address

75 JUNCTION SQUARE DR
CONCORD MA
01742-3049
US

V. Phone/Fax

Practice location:
  • Phone: 508-422-8262
  • Fax:
Mailing address:
  • Phone: 508-422-8262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROGER JOHN MARTINKUS JR.
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 205-422-8262