Healthcare Provider Details

I. General information

NPI: 1235057910
Provider Name (Legal Business Name): XIANGMIN MAO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 SOUTHERN BLVD
BRONX NY
10459-2417
US

IV. Provider business mailing address

202 W 96TH ST APT 1D
NEW YORK NY
10025-6375
US

V. Phone/Fax

Practice location:
  • Phone: 845-871-1000
  • Fax:
Mailing address:
  • Phone: 814-873-5374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: