Healthcare Provider Details

I. General information

NPI: 1275342123
Provider Name (Legal Business Name): THRIVE MIND HEALTH AND HOLISTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BERGEN ST APT 1L
BROOKLYN NY
11238-5193
US

IV. Provider business mailing address

760 BERGEN ST APT 1L
BROOKLYN NY
11238-5193
US

V. Phone/Fax

Practice location:
  • Phone: 917-268-7519
  • Fax: 917-268-7664
Mailing address:
  • Phone: 917-268-7519
  • Fax: 917-268-7664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MARCEL ANTHONY GREEN
Title or Position: PHYSICIAN
Credential: MD
Phone: 917-268-7519