Healthcare Provider Details

I. General information

NPI: 1841902145
Provider Name (Legal Business Name): RESILIENT MINDS PSYCHIATRY NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 SPRINGFIELD AVE # 206
SUMMIT NJ
07901-2622
US

IV. Provider business mailing address

467 SPRINGFIELD AVE # 206
SUMMIT NJ
07901-2622
US

V. Phone/Fax

Practice location:
  • Phone: 908-308-2048
  • Fax:
Mailing address:
  • Phone: 908-308-2048
  • Fax:

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

VIII. Authorized Official

Name: MS. MEGHAN CARR
Title or Position: OWNER AND PROVIDER
Credential: APN
Phone: 908-308-2048