Healthcare Provider Details

I. General information

NPI: 1053955096
Provider Name (Legal Business Name): MIND YOUR MIND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2019
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2083 KLOCKNER RD
HAMILTON NJ
08690-3415
US

IV. Provider business mailing address

7 HERNANDEZ CT
OLD BRIDGE NJ
08857-4406
US

V. Phone/Fax

Practice location:
  • Phone: 732-580-9096
  • Fax: 640-888-7533
Mailing address:
  • Phone: 732-580-9096
  • Fax: 640-888-7533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TANYA DUBINSKY
Title or Position: OWNER / PRESIDENT
Credential:
Phone: 732-580-9096