=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629944335
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOLARA MIND BEHAVIORAL HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2025
-----------------------------------------------------
Last Update Date | 10/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 578 MAIN STREET UNIT 202B
-----------------------------------------------------
City | MALDEN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-919-2945
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 STONE LN APT 5147
-----------------------------------------------------
City | MALDEN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02148-1573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-919-2945
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIC NURSE PRACTITIONER
-----------------------------------------------------
Name | CARLA MERLOS CHINDONGO
-----------------------------------------------------
Credential | MSN, APRN, PMHNP-BC
-----------------------------------------------------
Telephone | 857-919-2945
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------