Declan Fotoh, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

2024058381 Issued in MA

Practice address

600 Pine St
Lowell, MA 01851-2309

Phone

(978) 726-0056

NPI assigned

Jul 5, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wisdom Community Health LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Lowell, MA
  • NPI 1003751850

  MA, Psychiatric/Mental Health

  Medicare reassignment NPD Authorized official
• All in One Caregivers Mental Health Services Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • Taunton, MA
  • NPI 1427788751

  MA, Psychiatric/Mental Health

  Medicare reassignment NPD
• Supportive Behavioral Care of Ma LLC

  • Clinical Psychologist
  • Needham, MA
  • NPI 1780115519

  MA

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720137600000",
    "number": "1063258341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 PINE ST",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "018512309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 PINE ST",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "018512309",
            "telephone_number": "978-726-0056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOTOH",
        "first_name": "DECLAN",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-05",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "2024058381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amin Forkwa Inocent
• Suzanne Forsythe
• Caroline Ashley Fortin, MA
• Jessica Fortin, O.D.
• Leah Marie Fossett
• Jessica Fournier, MD
• Beth W Fowler, LICSW
• Kyle B Fowler
• Meghan Fowler
• Wayne A Fowler, O.D.

• All providers in Lowell, MA
• Psychiatric/Mental Health Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.