Provider Demographics
NPI:1962037473
Name:FRONTLINE PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:FRONTLINE PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:NIXON
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNAY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:917-587-1341
Mailing Address - Street 1:1 W FOSTER ST STE 11
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3879
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 W FOSTER ST STE 11
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3879
Practice Address - Country:US
Practice Address - Phone:917-587-1341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty