Healthcare Provider Details

I. General information

NPI: 1023999604
Provider Name (Legal Business Name): ME, MYSELF, & MIND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CENTENNIAL DR STE 219
PEABODY MA
01960-7939
US

IV. Provider business mailing address

9 CENTENNIAL DR FL 2 SUITE 219
PEABODY MA
01960-7939
US

V. Phone/Fax

Practice location:
  • Phone: 617-500-3513
  • Fax: 617-500-3513
Mailing address:
  • Phone: 617-500-3513
  • Fax: 617-500-3513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN DOUCET
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 781-214-1929