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General NPI Number Information
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NPI Number | 1023999604
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Entity Type | Organization
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Legal Business Name | ME, MYSELF, & MIND, LLC
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 40 SHATTUCK RD STE 228
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City | ANDOVER
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State | MA
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Zip | 01810-2459
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Country | US
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Telephone | 617-500-3513
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Fax |
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Provider Business Mailing Address
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Address Line | 9 CENTENNIAL DR FL 2
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City | PEABODY
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State | MA
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Zip | 01960-7939
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Country | US
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Telephone | 617-500-3513
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JUSTIN DODGE
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Credential | LICSW
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Telephone | 617-500-3513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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