Healthcare Provider Details

I. General information

NPI: 1073904140
Provider Name (Legal Business Name): MHM HEALTH PROFESSIONALS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HAVARD ROAD
SHIRLEY MA
01464
US

IV. Provider business mailing address

1593 SPRING HILL RD SUITE 610
VIENNA VA
22182-2245
US

V. Phone/Fax

Practice location:
  • Phone: 978-425-4341
  • Fax:
Mailing address:
  • Phone: 703-749-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2269378
License Number StateMA

VIII. Authorized Official

Name: DR. TOM GROBLEWSKI
Title or Position: STATEWIDE MEDICAL DIRECTOR
Credential:
Phone: 508-285-4018