LAKESIDE MENTAL HEALTH, PLLC (NPI# 1619494168) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619494168 |
| Entity Type | Organization |
| Organization Name | LAKESIDE MENTAL HEALTH, PLLC |
| Practice Address |
104 Charles Eldridge Drive Ste 1 Lakeville MA 02347-1388 |
| Mailing Address |
104 Charles Eldridge Drive Ste 1 Lakeville MA 02347 |
| Practice Telephone | 7742139332 |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2017-08-25 |
| Authorized Official Name | MRS. EMILY-ROSE MONTGOMERY VIRDEN (OWNER/ NURSE PRACTITIONER) |
| Authorized Official Telephone | 7742139332 |
| Authorized Official Credential | PMHNP-BC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
2992320 | MA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
104 CHARLES ELDRIDGE DRIVE STE 1 |
| City | LAKEVILLE |
| State | MA |
| Zip Code | 02347-1388 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902424302 | Sherry Ann Szczepkowski-demoura | Nurse Practitioner | 82 Freetown Street, Lakeville, MA 02347 | 2020-07-12 |
| 1730678038 | Wagner Pt & Performance LLC | Clinic/Center | 290 Bedford St, Lakeville, MA 02347 | 2018-05-02 |
| 1275960478 | Scott Michael Jarvis | Social Worker | 5 Bells Brook Rd, Lakeville, MA 02347 | 2013-10-02 |
| 1508034240 | Nelia M. Rodelle | Technician/Technologist | 47 Fuller Shores Road, Lakeville, MA 02347 | 2008-02-15 |
| 1497951594 | Lakeville Physical Therapy Inc | Physical Therapist | 155 Millennium Cir, Suite 114, Lakeville, MA 02347 | 2007-06-25 |
| 1609901875 | Lift & Care Systems, Inc. | Durable Medical Equipment & Medical Supplies | 7 Precinct Street, Lakeville, MA 02347 | 2007-02-21 |
| 1154479582 | Stephen Givinal Gouveia | Physical Therapist | 155 Millenium Dr, Lakeville Physical Therapy Inc Suite 114, Lakeville, MA 02347 | 2007-01-08 |
| 1992802615 | George Palaiologos | Chiropractor | 66 Main Street, Lakeville, MA 02347 | 2006-09-17 |
| 1326055419 | Cameron Luree Marzelli | Psychologist | 104 Charles Eldredge Drive, Lakeville, MA 02347 | 2006-08-02 |
| 1740295617 | Paige A Leavitt-halsall | Registered Nurse | 104 Charles Eldridge Drive, Tranquil Mind & Wellness Inc, Lakeville, MA 02347 | 2006-07-29 |
| Find all providers in zip 02347 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669610671 | Jill Marie Ell | Nurse Practitioner | 7580 160th St W, Lakeville, MN 55044-8348 | 2009-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225639552 | Kelly Ann Hancock | Nurse Practitioner | 6 Margot Ln, East Bridgewater, MA 02333-1689 | 2020-11-03 |
| 1366042715 | Jacqueline Ann Owens | Nurse Practitioner | 32 Hammond Ave, Cohasset, MA 02025-1928 | 2020-10-27 |
| 1144829177 | Amiee N Caruso | Nurse Practitioner | 26 Queen St Ste 4, Worcester, MA 01610-2473 | 2020-10-21 |
| 1629676234 | Sandpiper Wellness, LLC | Nurse Practitioner | 345 Union St Unit 5, New Bedford, MA 02740-3679 | 2020-10-15 |
| 1912505777 | Samantha Deglaoui | Nurse Practitioner | 1 Clarks Hl Ste 302, Framingham, MA 01702-8172 | 2020-10-14 |
| 1699372235 | Square Behavioral Health, LLC | Nurse Practitioner | 733 Turnpike St # 162, North Andover, MA 01845-6137 | 2020-10-06 |
| 1184221046 | Abdonne Ngo Nyele Mbouadeu | Nurse Practitioner | 34 Tannery Rd, Sturbridge, MA 01518-1171 | 2020-10-05 |
| 1013524164 | Atlee Quarrier | Nurse Practitioner | 29 Birch Meadow Rd, Merrimac, MA 01860-1826 | 2020-09-23 |
| 1669086997 | Unique Psych Services LLC | Nurse Practitioner | 10 Mazzeo Dr Ste 201f, Randolph, MA 02368-3433 | 2020-09-03 |
| 1457961138 | Savina Nicole Setze | Nurse Practitioner | 15 N Beacon St Apt 914, Allston, MA 02134-1941 | 2020-08-06 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on LAKESIDE MENTAL HEALTH, PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.