Healthcare Provider Details

I. General information

NPI: 1083478721
Provider Name (Legal Business Name): VIBRANT MINDS AND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 ALBION ST STE B4
WAKEFIELD MA
01880-2801
US

IV. Provider business mailing address

29 ALBION ST STE B4
WAKEFIELD MA
01880-2801
US

V. Phone/Fax

Practice location:
  • Phone: 781-314-0002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARMEN GUY
Title or Position: OWNER/APRN
Credential:
Phone: 781-314-0002