Healthcare Provider Details

I. General information

NPI: 1144880550
Provider Name (Legal Business Name): LWM MENTAL HEALTH SPECIALIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 PLAZA STREET EAST SUITE 102
BROOKLYN NY
11238
US

IV. Provider business mailing address

34 PLAZA STREET EAST SUITE 102
BROOKLYN NY
11238
US

V. Phone/Fax

Practice location:
  • Phone: 718-399-6852
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LAUREE WOLIN MITCHELL
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 718-399-6852