Provider Demographics
NPI:1386280535
Name:ENLIGHTENED PSYCHIATRY, LLC
Entity type:Organization
Organization Name:ENLIGHTENED PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAITNEIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MSN,PMHNP-BC, PNP-BC
Authorized Official - Phone:617-686-9802
Mailing Address - Street 1:54 CENTRAL ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01745-1032
Mailing Address - Country:US
Mailing Address - Phone:508-714-7604
Mailing Address - Fax:508-213-3968
Practice Address - Street 1:54 CENTRAL ST STE 2
Practice Address - Street 2:
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01745-1032
Practice Address - Country:US
Practice Address - Phone:508-714-7604
Practice Address - Fax:508-213-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)