# LAKESIDE MENTAL HEALTH, PLLC

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

## Provider details

- **NPI number:** 1619494168
- **Authorized official:** MRS. EMILY-ROSE MONTGOMERY VIRDEN PMHNP-BC (OWNER/ NURSE PRACTITIONER)
- **Authorized official phone:** (774) 213-9332

## Contact information

- **Practice address:** 104 CHARLES ELDRIDGE DRIVE STE 1, LAKEVILLE, MA 02347-1388
- **Practice address phone:** (774) 213-9332
- **Mailing address:** 104 CHARLES ELDRIDGE DRIVE STE 1, LAKEVILLE, MA 02347

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 2992320 | MA | Yes |

## Other

- **Enumeration date:** 08/25/2017
- **Last updated:** 08/25/2017