Healthcare Provider Details

I. General information

NPI: 1831924737
Provider Name (Legal Business Name): PSYCHCONCIERGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 BOSTON RD
SPRINGFIELD MA
01109-1211
US

IV. Provider business mailing address

361 BOSTON RD
SPRINGFIELD MA
01109-1211
US

V. Phone/Fax

Practice location:
  • Phone: 617-855-8583
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DANIEL NEWMAN
Title or Position: CLINICIAN
Credential:
Phone: 617-855-8583