Healthcare Provider Details

I. General information

NPI: 1851211874
Provider Name (Legal Business Name): MIND HARBOR NURSE PRACTITIONER IN PSYCHIATRY SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 E 56TH STREET
BROOKLYN NY
11234
US

IV. Provider business mailing address

1280 LEXINGTON AVE FRNT 2
NEW YORK NY
10028-2136
US

V. Phone/Fax

Practice location:
  • Phone: 484-542-3768
  • Fax:
Mailing address:
  • Phone: 484-542-3768
  • 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: JERMAINE NNAETO
Title or Position: OWNER
Credential:
Phone: 484-542-3768