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General NPI Number Information
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NPI Number | 1093597494
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Entity Type | Organization
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Legal Business Name | MERCURIUS PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 10/19/2023
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 15 FOREST RD STE F
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City | HANCOCK
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State | NH
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Zip | 03449-6111
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Country | US
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Telephone | 617-866-7697
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Fax |
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Provider Business Mailing Address
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Address Line | 15 FOREST RD STE F
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City | HANCOCK
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State | NH
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Zip | 03449-6111
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Country | US
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Telephone | 617-866-7697
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | JASON ADAM BENNETT
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Credential | PMHNP-BC
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Telephone | 617-866-7697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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