Healthcare Provider Details

I. General information

NPI: 1053174235
Provider Name (Legal Business Name): PSYCHIATRY AND PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 DWIGHT RD STE 103
LONGMEADOW MA
01106-1768
US

IV. Provider business mailing address

171 DWIGHT RD STE 103
LONGMEADOW MA
01106-1768
US

V. Phone/Fax

Practice location:
  • Phone: 413-200-0769
  • Fax: 877-421-3866
Mailing address:
  • Phone: 413-200-0769
  • Fax: 877-421-3866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KELVIN KARANJA
Title or Position: CO-FOUNDER
Credential:
Phone: 413-200-0769