Provider Demographics
NPI: | 1649163650 |
---|---|
Name: | WEBSTER PSYCHIATRIC CENTER |
Entity type: | Organization |
Organization Name: | WEBSTER PSYCHIATRIC CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | NURSE PRACTITIONER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | THERESA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WEBSTER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PMHNP |
Authorized Official - Phone: | 978-404-1722 |
Mailing Address - Street 1: | 1500 DISTRICT AVE # 4877 |
Mailing Address - Street 2: | |
Mailing Address - City: | BURLINGTON |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 01803-5069 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 978-404-0808 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1500 DISTRICT AVE # 4877 |
Practice Address - Street 2: | |
Practice Address - City: | BURLINGTON |
Practice Address - State: | MA |
Practice Address - Zip Code: | 01803-5069 |
Practice Address - Country: | US |
Practice Address - Phone: | 978-404-0808 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2025-05-29 |
Last Update Date: | 2025-05-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Single Specialty |