MEDICARE: HEALTHIER MINDS PSYCHOANALYSIS AND PSYCHOLOGICAL SERVICES, 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	103TP0814X	Psychoanalysis Psychologist

General Provider Information

NPI Number	:	1578309977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHIER MINDS PSYCHOANALYSIS AND PSYCHOLOGICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 140580
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-0580
Country	:	US
Telephone Number	:	718-954-5260
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 GLEN AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-2823
Country	:	US
Telephone Number	:	718-954-5260
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND DIRECTOR
Name	:	DR. SHIRLEY DISU
Credential	:	PSYD., LP
Telephone Number	:	718-954-5260

Provider Enumeration Date	:	07/04/2024
Last Update Date	:	07/04/2024

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