Provider Demographics
NPI:1306119854
Name:MUTTO, EVA NAMAKULA (PMHN-BC)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:NAMAKULA
Last Name:MUTTO
Suffix:
Gender:F
Credentials:PMHN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 TECHNOLOGY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-2441
Mailing Address - Country:US
Mailing Address - Phone:978-677-6354
Mailing Address - Fax:978-677-6456
Practice Address - Street 1:7 TECHNOLOGY DR STE 102
Practice Address - Street 2:
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2441
Practice Address - Country:US
Practice Address - Phone:978-677-6354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2271100163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse