Provider Demographics
NPI:1174257919
Name:HANOVER PSYCHIATRY GROUP LLC
Entity type:Organization
Organization Name:HANOVER PSYCHIATRY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELISLE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHCNS-BC
Authorized Official - Phone:781-924-6080
Mailing Address - Street 1:273 HANOVER ST STE 7
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-2234
Mailing Address - Country:US
Mailing Address - Phone:617-538-8232
Mailing Address - Fax:857-344-0023
Practice Address - Street 1:273 HANOVER ST STE 7
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-2234
Practice Address - Country:US
Practice Address - Phone:617-538-8232
Practice Address - Fax:857-344-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty