Provider Demographics
NPI:1194233320
Name:MIDDLESEX PSYCHIATRY, PLLC
Entity type:Organization
Organization Name:MIDDLESEX PSYCHIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SIMONEAU
Authorized Official - Suffix:
Authorized Official - Credentials:CNS, NP
Authorized Official - Phone:508-306-1319
Mailing Address - Street 1:121 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1986
Mailing Address - Country:US
Mailing Address - Phone:508-306-1319
Mailing Address - Fax:508-861-0156
Practice Address - Street 1:847 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-1685
Practice Address - Country:US
Practice Address - Phone:508-306-1319
Practice Address - Fax:508-861-0156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN266987261QM0801X, 363LP0808X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty