Lakeside Mental Health, PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

2992320 Issued in MA

Legal business name

LAKESIDE MENTAL HEALTH, PLLC

Practice address

104 Charles Eldridge Drive Ste 1
Lakeville, MA 02347-1388

Phone

(774) 213-9332

NPI assigned

Aug 25, 2017

Last updated

Aug 25, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Emily-Rose Montgomery Virden, PMHNP-BC

Title

Owner/ Nurse Practitioner

Phone

(774) 213-9332

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1503619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503619200000",
    "number": "1619494168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 CHARLES ELDRIDGE DRIVE STE 1",
            "city": "LAKEVILLE",
            "state": "MA",
            "postal_code": "02347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 CHARLES ELDRIDGE DRIVE STE 1",
            "city": "LAKEVILLE",
            "state": "MA",
            "postal_code": "023471388",
            "telephone_number": "774-213-9332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MENTAL HEALTH, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-25",
        "last_updated": "2017-08-25",
        "status": "A",
        "authorized_official_last_name": "VIRDEN",
        "authorized_official_first_name": "EMILY-ROSE",
        "authorized_official_middle_name": "MONTGOMERY",
        "authorized_official_title_or_position": "OWNER/ NURSE PRACTITIONER",
        "authorized_official_telephone_number": "774-213-9332",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "2992320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ginny Lynn Kelly, LICSW
• Ghassan A Khoury, DMD,MPH,PC
• Cherie Kish, HIS
• Jennifer L Koester, MSN, APRN, FNP-C
• Judy Kohut
• Lakeville Chiropractic, Inc
• Lakeville Dental Associates, P.C.
• Lakeville Family Medicine PC
• Lakeville Physical Therapy Inc
• Kristy Lamoureux, AU.D

• Psychiatric/Mental Health Nurse Practitioner in Lakeville, MA
• Providers in Lakeville, MA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2017; 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.