MEDICARE: NEAR MIND NP IN PSYCHIATRY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1134084940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEAR MIND NP IN PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	28 LIBERTY BLVD
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-4834
Country	:	US
Telephone Number	:	347-737-3009
Fax Number	:	347-737-3009

Provider Business Practice Location Address
First Line	:	28 LIBERTY BLVD
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-4834
Country	:	US
Telephone Number	:	347-737-3009
Fax Number	:	347-737-3009

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SMITH MAXUME
Credential	:	PMHNP-BC
Telephone Number	:	347-737-3009

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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