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General NPI Number Information
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NPI Number | 1912747353
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Entity Type | Organization
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Legal Business Name | WILLOW BEND PSYCHIATRIC CARE, PLLC
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Dates
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Enumeration Date | 05/31/2024
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 269 MIDDLESEX RD
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City | TYNGSBORO
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State | MA
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Zip | 01879-1078
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Country | US
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Telephone | 978-488-9400
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Fax | 978-488-9480
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Provider Business Mailing Address
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Address Line | 8 SYCAMORE ST
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City | CHELMSFORD
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State | MA
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Zip | 01824-1134
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | AMANDA ROSE SULLIVAN
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Credential | DNP, APRN, PMHNP-BC
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Telephone | 508-341-7886
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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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