Provider Demographics
NPI:1043044944
Name:SUDBURY RIVER THERAPY PLLC
Entity type:Organization
Organization Name:SUDBURY RIVER THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:SIU
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, PMHNP-BC
Authorized Official - Phone:978-219-4040
Mailing Address - Street 1:260 BOSTON POST RD STE 10
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1888
Mailing Address - Country:US
Mailing Address - Phone:978-219-4040
Mailing Address - Fax:978-496-8386
Practice Address - Street 1:260 BOSTON POST RD STE 10
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-1888
Practice Address - Country:US
Practice Address - Phone:978-219-4040
Practice Address - Fax:978-496-8386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-02
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty