Healthcare Provider Details

I. General information

NPI: 1174380141
Provider Name (Legal Business Name): MINDFUL CARE NP IN PSYCHIATRY AND NP IN ADULT HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 E 19TH ST APT 6B
BROOKLYN NY
11226-7674
US

IV. Provider business mailing address

571 E 19TH ST APT 6B
BROOKLYN NY
11226-7674
US

V. Phone/Fax

Practice location:
  • Phone: 929-322-1924
  • Fax:
Mailing address:
  • Phone: 929-274-5188
  • Fax: 929-274-5330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERICKA DEADWYLER-GOURGUE
Title or Position: OWNER
Credential: NP
Phone: 929-274-5188