Healthcare Provider Details

I. General information

NPI: 1134065634
Provider Name (Legal Business Name): MASTERMIND BEHAVIOR SERVICES NM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 W 21ST ST # 1001
CLOVIS NM
88101-4023
US

IV. Provider business mailing address

410 MONMOUTH AVE APT 100
LAKEWOOD NJ
08701-3747
US

V. Phone/Fax

Practice location:
  • Phone: 732-813-7333
  • Fax:
Mailing address:
  • Phone: 732-813-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. RAIZY PERLSTEIN
Title or Position: OWNER
Credential:
Phone: 732-813-7333