Healthcare Provider Details

I. General information

NPI: 1952892739
Provider Name (Legal Business Name): FRANCISCO COVINO-DEASO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2018
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HIGHLAND AVE SUITE 201
SALEM MA
01970-2714
US

IV. Provider business mailing address

55 HIGHLAND HALL SUITE 201
SALEM, MA MA
01970
US

V. Phone/Fax

Practice location:
  • Phone: 978-354-2237
  • Fax:
Mailing address:
  • Phone: 978-825-6620
  • Fax: 978-825-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2322157
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2322157
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: