Healthcare Provider Details

I. General information

NPI: 1760960769
Provider Name (Legal Business Name): BETTY YU PMHNP-BC, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1391 MAIN ST STE 104
WALPOLE MA
02081-1767
US

IV. Provider business mailing address

1391 MAIN ST STE 104
WALPOLE MA
02081-1767
US

V. Phone/Fax

Practice location:
  • Phone: 617-991-9151
  • Fax: 617-250-8262
Mailing address:
  • Phone: 617-991-9151
  • Fax: 617-250-8262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number085782-23
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2303520
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14083
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2303520
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: