MEDICARE: MINDFRAME, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1356103022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFRAME, LLC

Provider Business Mailing Address
First Line	:	155 WILLOWBROOK BLVD
Second Line	:	SUITE 110 #4273
City	:	WAYNE
State	:	NJ
Zip	:	07470-7033
Country	:	US
Telephone Number	:	201-472-3694
Fax Number	:	346-463-7124

Provider Business Practice Location Address
First Line	:	155 WILLOWBROOK BLVD # 4273
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-7032
Country	:	US
Telephone Number	:	201-472-3694
Fax Number	:	346-463-7124

Authorized Official
Title or Position	:	PMHNP-BC
Name	:	MS. MELISSA J MCCALISTER
Credential	:	ANP
Telephone Number	:	201-472-3694

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	02/13/2024

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