=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730806589
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOMETOWN MENTAL HEALTH SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2022
-----------------------------------------------------
Last Update Date | 10/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 157 PAIGE HILL RD
-----------------------------------------------------
City | BRIMFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01010-9779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-668-7177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 157 PAIGE HILL RD
-----------------------------------------------------
City | BRIMFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01010-9779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-668-7177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GEENA NOVINSKY
-----------------------------------------------------
Credential | NURSE PRACTITIONER
-----------------------------------------------------
Telephone | 413-668-7177
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------