Healthcare Provider Details

I. General information

NPI: 1992465157
Provider Name (Legal Business Name): INCLUSIVE MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 CO OP CITY BLVD APT 14D
BRONX NY
10475-1634
US

IV. Provider business mailing address

920 CO OP CITY BLVD APT 14D
BRONX NY
10475-1634
US

V. Phone/Fax

Practice location:
  • Phone: 347-697-3037
  • Fax:
Mailing address:
  • Phone: 347-697-3037
  • Fax:

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: VINESSA MAXWELL
Title or Position: MANAGER
Credential: PMHNP-BC
Phone: 347-697-3037