Healthcare Provider Details

I. General information

NPI: 1376983056
Provider Name (Legal Business Name): MENDING OUR MINDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CHURCH ST STE 101
MONTCLAIR NJ
07042-2772
US

IV. Provider business mailing address

50 CHURCH ST STE 101
MONTCLAIR NJ
07042-2772
US

V. Phone/Fax

Practice location:
  • Phone: 973-744-1192
  • Fax: 973-676-5801
Mailing address:
  • Phone: 973-744-1192
  • Fax: 973-676-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number26NC06850500
License Number StateNJ

VIII. Authorized Official

Name: MRS. SAUNDRA AUSTIN-BENN
Title or Position: OWNER
Credential: APN
Phone: 973-744-1192