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General NPI Number Information
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NPI Number | 1598349631
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Entity Type | Organization
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Legal Business Name | VANGUARD PSYCHIATRY LLC
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Dates
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Enumeration Date | 05/05/2021
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 221 W PATISON ST STE 203A
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City | PORT HADLOCK
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State | WA
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Zip | 98339-9751
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Country | US
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Telephone | 908-509-7764
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Fax | 360-369-6722
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Provider Business Mailing Address
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Address Line | 4935 STATE ROUTE 20
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City | PORT TOWNSEND
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State | WA
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Zip | 98368-9701
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Country | US
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Telephone | 650-753-1193
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MR. MICHAEL MATTHEW DEFILIPPO
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Credential | DNP, ARNP
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Telephone | 650-753-1193
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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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