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General NPI Number Information
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NPI Number | 1174257919
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Entity Type | Organization
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Legal Business Name | HANOVER PSYCHIATRY GROUP LLC
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 273 HANOVER ST STE 7
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City | HANOVER
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State | MA
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Zip | 02339-2234
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Country | US
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Telephone | 617-538-8232
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Fax | 857-344-0023
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Provider Business Mailing Address
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Address Line | 273 HANOVER ST STE 7
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City | HANOVER
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State | MA
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Zip | 02339-2234
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Country | US
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Telephone | 617-538-8232
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Fax | 857-344-0023
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Authorized Official
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Title or Position | OWNER
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Name | LESLIE A DELISLE
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Credential | APRN, PMHCNS-BC
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Telephone | 781-924-6080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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