Healthcare Provider Details

I. General information

NPI: 1992938781
Provider Name (Legal Business Name): CHERYL DOUCETTE, ANP-BC, PMHCNS-BC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 BROWN ST SUITE 505
HAVERHILL MA
01830-6778
US

IV. Provider business mailing address

62 BROWN ST SUITE 505
HAVERHILL MA
01830-6778
US

V. Phone/Fax

Practice location:
  • Phone: 978-521-8810
  • Fax: 978-521-8811
Mailing address:
  • Phone: 978-521-8810
  • Fax: 978-521-8811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number216207
License Number StateMA

VIII. Authorized Official

Name: CHERYL DOUCETTE
Title or Position: CLINICAL NURSE SPECIALIST
Credential: ANP-BC, PMHCNS-BC
Phone: 978-521-8810