Organization
MAGNOLIA BEHAVIORAL HEALTH SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIRVA LAFONTANT (OWNER)
(617) 435-4633
Entity
Organization
Contact information
Practice address
247 N MAIN ST STE 13, RANDOLPH, MA 02368-4172
(617) 435-4633
Mailing address
247 N MAIN ST STE 13, RANDOLPH, MA 02368-4172
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/23/2024
Last updated
06/20/2024
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