Eastern Light Psychiatry

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

EASTERN LIGHT PSYCHIATRY

Practice address

333 Blakes Hill Rd
Northwood, NH 03261-3930

Phone

(208) 313-9590

NPI assigned

Nov 30, 2023

Organization subpart

No

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

Authorized official

Name

Michael Scott Jr., APRN, PMHNP-BCNPI 1063058931

Title

Owner

Phone

(208) 313-9590

Specialties & licenses 3

Addresses

Tax ID family

Eastern Light Psychiatry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Eastern Light Psychiatry

  • Family Nurse Practitioner
  • Concord, NH
  • NPI 1194555771
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Scott, APRN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Manchester, NH
  • NPI 1063058931
  NPD Authorized official

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

{
    "created_epoch": "1701302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708819200000",
    "number": "1336915495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 BLAKES HILL RD",
            "city": "NORTHWOOD",
            "state": "NH",
            "postal_code": "032613930",
            "telephone_number": "208-313-9590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 BLAKES HILL RD",
            "city": "NORTHWOOD",
            "state": "NH",
            "postal_code": "032613930",
            "telephone_number": "208-313-9590"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 Foundry St Fl 2",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NH",
            "postal_code": "033015419",
            "country_code": "US",
            "telephone_number": "603-605-0882",
            "fax_number": "603-696-3217",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EASTERN LIGHT PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-30",
        "last_updated": "2024-02-25",
        "certification_date": "2024-02-25",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-313-9590",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "APRN, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Samantha Kaitlyn Domenichello, RDH
• Shelley M Dupont, RDH
• Leah Marie Foley, APRN
• Alison E Gomes, D.M.D.
• Hannaford Bros Co LLC
• John R Henry, RPH
• Natalie Ilea, DMD

• Psychiatric/Mental Health Nurse Practitioner in Northwood, NH
• Providers in Northwood, NH by specialty
• Psychiatric/Mental Health Nurse Practitioner in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.