Healthcare Provider Details

I. General information

NPI: 1790642122
Provider Name (Legal Business Name): ELEVATION BEHAVIORAL HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3203 FLUVIAL LN APT 303
LAUREL MD
20724-0084
US

IV. Provider business mailing address

3203 FLUVIAL LN APT 303
LAUREL MD
20724-0084
US

V. Phone/Fax

Practice location:
  • Phone: 781-325-2797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DEBORAH NAKATO
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 781-325-2797