Provider Demographics
NPI:1326812611
Name:MIND MATTERS THERAPEUTICS
Entity type:Organization
Organization Name:MIND MATTERS THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:DESPINA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC, AGNP
Authorized Official - Phone:860-833-3173
Mailing Address - Street 1:41 TRIANGLE CIR
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-2497
Mailing Address - Country:US
Mailing Address - Phone:860-833-3173
Mailing Address - Fax:
Practice Address - Street 1:1500 DISTRICT AVE
Practice Address - Street 2:STE 1907
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803
Practice Address - Country:US
Practice Address - Phone:860-833-3173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty