Organization
LAKESIDE MENTAL HEALTH, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EMILY-ROSE MONTGOMERY VIRDEN PMHNP-BC (OWNER/ NURSE PRACTITIONER)
(774) 213-9332
Entity
Organization
Contact information
Practice address
104 CHARLES ELDRIDGE DRIVE STE 1, LAKEVILLE, MA 02347-1388
(774) 213-9332
Mailing address
104 CHARLES ELDRIDGE DRIVE STE 1, LAKEVILLE, MA 02347
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2992320
MA
Other
Enumeration date
08/25/2017
Last updated
08/25/2017
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