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General NPI Number Information
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NPI Number | 1871427021
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Entity Type | Organization
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Legal Business Name | MOONPHASE INTEGRATIVE PSYCHIATRY & WELLNESS, PLLC
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Dates
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Enumeration Date | 06/11/2026
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Last Update Date | 06/11/2026
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Provider Practice Location Address
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Address Line | 20 CABOT BLVD STE 300
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City | MANSFIELD
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State | MA
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Zip | 02048-1183
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Country | US
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Telephone | 508-690-0688
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Fax |
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Provider Business Mailing Address
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Address Line | 235 MANCHAUG RD
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City | SUTTON
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State | MA
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Zip | 01590-1647
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Country | US
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Telephone | 339-215-8115
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Fax |
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Authorized Official
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Title or Position | OWNER, MANAGING MBR
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Name | MICHELE WHITAKER
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Credential | MSN, APRN,PMHNP-BC
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Telephone | 508-566-4032
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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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