Provider Demographics
NPI:1053174235
Name:PSYCHIATRY AND PRIMARY CARE
Entity type:Organization
Organization Name:PSYCHIATRY AND PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:KARANJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-200-0769
Mailing Address - Street 1:15 BENTON DR STE 10
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-3232
Mailing Address - Country:US
Mailing Address - Phone:413-200-0769
Mailing Address - Fax:877-421-3866
Practice Address - Street 1:15 BENTON DR STE 10
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-3232
Practice Address - Country:US
Practice Address - Phone:413-200-0769
Practice Address - Fax:877-421-3866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-31
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110187099AMedicaid