Healthcare Provider Details

I. General information

NPI: 1154056976
Provider Name (Legal Business Name): AIREN B BRICENO DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 PLEASANT ST
LYNN MA
01901-1524
US

IV. Provider business mailing address

254 LYNNWAY APT 314
LYNN MA
01901-1848
US

V. Phone/Fax

Practice location:
  • Phone: 617-461-8781
  • Fax:
Mailing address:
  • Phone: 617-461-8781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN2314047
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2314047
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: