Healthcare Provider Details

I. General information

NPI: 1194233320
Provider Name (Legal Business Name): MIDDLESEX PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 WASHINGTON ST
HOLLISTON MA
01746-1685
US

IV. Provider business mailing address

121 CEDAR ST
ASHLAND MA
01721-1986
US

V. Phone/Fax

Practice location:
  • Phone: 508-306-1319
  • Fax: 508-861-0156
Mailing address:
  • Phone: 508-306-1319
  • Fax: 508-861-0156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberRN266987
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN266987
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN266987
License Number StateMA

VIII. Authorized Official

Name: JAMIE NICOLE SIMONEAU
Title or Position: MANAGER
Credential: CNS, NP
Phone: 508-306-1319