MEDICARE: MINDFUL CONNECTIONS 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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1881411817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL CONNECTIONS PSYCHOLOGICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	11 NEW KARNER RD UNIT 311
Second Line	:
City	:	GUILDERLAND
State	:	NY
Zip	:	12084-6214
Country	:	US
Telephone Number	:	518-227-0396
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 STANLEY CIR STE 11
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-2606
Country	:	US
Telephone Number	:	518-227-0396
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. LINA HERNANDEZ
Credential	:	PSD
Telephone Number	:	518-227-0396

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	05/07/2026

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