Healthcare Provider Details

I. General information

NPI: 1487004883
Provider Name (Legal Business Name): PSYCHIATRIC MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 NEW BOSTON ST SUITE U-168
WOBURN MA
01801-6297
US

IV. Provider business mailing address

155 NEW BOSTON ST SUITE U-168
WOBURN MA
01801-6297
US

V. Phone/Fax

Practice location:
  • Phone: 781-941-6326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberRN280868
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberRN280868
License Number StateMA

VIII. Authorized Official

Name: HUONG MADRIGAL
Title or Position: OWNER
Credential: APRN, PMHNP-BC
Phone: 781-341-6326