# MAGNOLIA BEHAVIORAL HEALTH SERVICES PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235995648
- **Authorized official:** NIRVA LAFONTANT (OWNER)
- **Authorized official phone:** (617) 435-4633

## Contact information

- **Practice address:** 247 N MAIN ST STE 13, RANDOLPH, MA 02368-4172
- **Practice address phone:** (617) 435-4633
- **Mailing address:** 247 N MAIN ST STE 13, RANDOLPH, MA 02368-4172

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/23/2024
- **Last updated:** 06/20/2024