Healthcare Provider Details

I. General information

NPI: 1831018639
Provider Name (Legal Business Name): MAYBELLE MBIATEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W FOSTER ST STE 2
MELROSE MA
02176-3879
US

IV. Provider business mailing address

1 W FOSTER ST STE 2
MELROSE MA
02176-3879
US

V. Phone/Fax

Practice location:
  • Phone: 617-935-8829
  • Fax:
Mailing address:
  • Phone: 617-935-8829
  • 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: MAYBELLE MBIATEM
Title or Position: OWNER
Credential:
Phone: 617-259-6475