Healthcare Provider Details

I. General information

NPI: 1316772106
Provider Name (Legal Business Name): MINDFUL WAYS PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 WENDELL AVE STE 100
PITTSFIELD MA
01201-7066
US

IV. Provider business mailing address

2310 ARCHSTONE AVE
TEWKSBURY MA
01876-1864
US

V. Phone/Fax

Practice location:
  • Phone: 978-645-1400
  • Fax:
Mailing address:
  • Phone: 978-645-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FRANK TENGEY
Title or Position: OWNER NP
Credential:
Phone: 978-645-1400