Healthcare Provider Details

I. General information

NPI: 1821995689
Provider Name (Legal Business Name): WIDLYNE CETOUTE JEUNE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2026
Last Update Date: 10/23/2026
Certification Date: 10/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 AYLES RD
HYDE PARK MA
02136-3727
US

IV. Provider business mailing address

60 AYLES RD
HYDE PARK MA
02136-3727
US

V. Phone/Fax

Practice location:
  • Phone: 781-363-6873
  • Fax:
Mailing address:
  • Phone: 781-363-6873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2300119
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: