| Mercury Newco Inc | |
|
580 Harrison Ave Ste 2b Boston MA 02118-2440 | |
| (224) 622-5470 | |
| Not Available |
| Full Name | Mercury Newco Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 580 Harrison Ave Ste 2b, Boston, Massachusetts |
| Authorized Official Name and Position | Sandra Charipper (CHIEF OF STAFF) |
| Authorized Official Contact | 2014001361 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mercury Newco Inc 580 Harrison Ave Ste 2b Boston MA 02118-2440 Ph: () - | Mercury Newco Inc 580 Harrison Ave Ste 2b Boston MA 02118-2440 Ph: (224) 622-5470 |
| NPI Number | 1174347850 |
|---|---|
| Provider Enumeration Date | 11/11/2024 |
| Last Update Date | 08/15/2025 |
| Certification Date | 08/15/2025 |
| Medicare PECOS PAC ID | 8426577966 |
|---|---|
| Medicare Enrollment ID | O20250528001245 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174347850 | NPI | - | NPPES |
| Provider Name | Jennie Byrne |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194947259 PECOS PAC ID: 8426122748 Enrollment ID: I20240916000810 |
| Provider Name | Nina Perales |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346689601 PECOS PAC ID: 4789958133 Enrollment ID: I20250411001504 |
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