Healthcare Provider Details

I. General information

NPI: 1396650594
Provider Name (Legal Business Name): WASHINGTON MWANGI PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 BELMONT ST
WORCESTER MA
01604-1059
US

IV. Provider business mailing address

16 ARROWSIC ST
WORCESTER MA
01606-4002
US

V. Phone/Fax

Practice location:
  • Phone: 508-368-4000
  • Fax:
Mailing address:
  • Phone: 774-578-4783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2026060260
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: