Healthcare Provider Details

I. General information

NPI: 1407761943
Provider Name (Legal Business Name): MIND MENDED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 MORRIS AVE STE 211
UNION NJ
07083-5914
US

IV. Provider business mailing address

2819 DEWITT TER
LINDEN NJ
07036-4803
US

V. Phone/Fax

Practice location:
  • Phone: 908-265-0407
  • Fax:
Mailing address:
  • Phone: 732-596-7364
  • Fax: 908-223-8516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VIVIANE VINOU-LEVY
Title or Position: PSYCHIATRIC NURSE PRACTIONER
Credential: PMHNP
Phone: 908-265-0407