Healthcare Provider Details

I. General information

NPI: 1437862067
Provider Name (Legal Business Name): MISSION WELLNESS PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 SOUTH RD
KENSINGTON NH
03833-6800
US

IV. Provider business mailing address

230 INDEPENDENCE WAY STE 1
DANVERS MA
01923-3692
US

V. Phone/Fax

Practice location:
  • Phone: 603-389-7180
  • Fax:
Mailing address:
  • Phone: 603-389-7180
  • 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: MR. GREGORY MARCELLIN
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 603-389-7180