Provider Demographics
NPI:1053095117
Name:MENDED ROOT
Entity type:Organization
Organization Name:MENDED ROOT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CATALDO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:617-212-0938
Mailing Address - Street 1:280 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1750
Mailing Address - Country:US
Mailing Address - Phone:617-212-0938
Mailing Address - Fax:
Practice Address - Street 1:6 LIBERTY SQUARE PMB 6181
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-5800
Practice Address - Country:US
Practice Address - Phone:802-500-1114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty