Healthcare Provider Details

I. General information

NPI: 1578320396
Provider Name (Legal Business Name): SALAMATA YEROH ALEX-KAMARA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 RIVERBANK RD
QUINCY MA
02169-3326
US

IV. Provider business mailing address

115 GRACE LN
STOUGHTON MA
02072-3859
US

V. Phone/Fax

Practice location:
  • Phone: 404-447-7071
  • Fax:
Mailing address:
  • Phone: 404-447-7071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2292441
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2292441
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: