Healthcare Provider Details

I. General information

NPI: 1942948351
Provider Name (Legal Business Name): AFFECT THERAPEUTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 CENTRAL AVE SW STE 19
ALBUQUERQUE NM
87102-2803
US

IV. Provider business mailing address

520 BROADWAY FL 4
NEW YORK NY
10012-4436
US

V. Phone/Fax

Practice location:
  • Phone: 845-769-8758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KARLA RENEE MULLINGS
Title or Position: DIRECTOR CLINICAL COMPLIANCE
Credential:
Phone: 323-522-2218