=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053210286
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAY STATE PSYCHIATRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2026
-----------------------------------------------------
Last Update Date | 11/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 82 WENDELL AVE STE 100
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201-7066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-829-9356
-----------------------------------------------------
Fax | 617-874-3582
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1660 SOLDIERS FIELD RD STE 7
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02135-1108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-829-9356
-----------------------------------------------------
Fax | 617-874-3582
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PMHNP
-----------------------------------------------------
Name | ANGELA ZAMMUTO
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 617-829-9356
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------