Provider Demographics
NPI:1124623806
Name:MODERN PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:MODERN PSYCHIATRIC SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER & PSYCH NP
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:BELLMAN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, PMHNP-BC
Authorized Official - Phone:617-546-6700
Mailing Address - Street 1:8 GROVE ST STE 400A
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7726
Mailing Address - Country:US
Mailing Address - Phone:617-546-6700
Mailing Address - Fax:617-546-6800
Practice Address - Street 1:8 GROVE ST STE 400A
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7726
Practice Address - Country:US
Practice Address - Phone:617-546-6700
Practice Address - Fax:617-546-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty