NPIMap

Organization Active NPI

Lighthouse Mental Wellness PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Pembroke, MA
National Provider Identifier
1821564790
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
LIGHTHOUSE MENTAL WELLNESS PLLC
Practice address
28 Riverside Dr Ste 260
Pembroke, MA 02359-4947
Phone
(781) 472-7070
Fax
(781) 472-7071
NPI assigned
Oct 18, 2018
Last updated
Jan 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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

Authorized official

Name
Brian Banks, PMHNP-BCNPI 1780067645
Title
Psychiatric NP/Owner
Phone
(781) 427-7070

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary

Addresses

Primary practice location

28 Riverside Dr Ste 260
Pembroke, MA 02359-4947

Mailing address

28 Riverside Dr Ste 260
Pembroke, MA 02359-4947
Phone (781) 427-7070

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address brian@lighthousementalwellness.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241004000665 MA Part B Supplier - Clinic/Group Practice 5698206324 Receives reassigned benefits from 6 practitioners
Practice locations: Pembroke, MA

National Provider Directory

National Provider Directory

Locations

28 Riverside Dr
Ste 260
Pembroke, MA 02359
Phone (781) 427-7070

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1539820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1821564790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 RIVERSIDE DR STE 260",
            "city": "PEMBROKE",
            "state": "MA",
            "postal_code": "023594947",
            "telephone_number": "781-427-7070",
            "fax_number": "781-472-7071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 RIVERSIDE DR STE 260",
            "city": "PEMBROKE",
            "state": "MA",
            "postal_code": "023594947",
            "telephone_number": "781-472-7070",
            "fax_number": "781-472-7071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE MENTAL WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-18",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "BANKS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "PSYCHIATRIC NP/OWNER",
        "authorized_official_telephone_number": "781-427-7070",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "brian@lighthousementalwellness.com",
            "affiliation": "N",
            "address_1": "28 Riverside Dr Ste 260",
            "city": "Pembroke",
            "state": "MA",
            "country_code": "US",
            "postal_code": "023594947",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pembroke, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.