Healthcare Provider Details

I. General information

NPI: 1962348755
Provider Name (Legal Business Name): GRANITE HEALTH AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 DERBY ST STE 200
HINGHAM MA
02043-4216
US

IV. Provider business mailing address

99 DERBY ST STE 200
HINGHAM MA
02043-4216
US

V. Phone/Fax

Practice location:
  • Phone: 508-205-9398
  • Fax:
Mailing address:
  • Phone: 508-205-9398
  • 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: LHASSANE OUMALEK
Title or Position: MANAGER
Credential: PMHNP-BC
Phone: 508-205-9398