Healthcare Provider Details

I. General information

NPI: 1649479817
Provider Name (Legal Business Name): ADVANCED MINDCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 W BROADWAY SUITE 2
HEWLETT NY
11557-1929
US

IV. Provider business mailing address

1234 W BROADWAY SUITE 2
HEWLETT NY
11557-1929
US

V. Phone/Fax

Practice location:
  • Phone: 516-376-0865
  • Fax:
Mailing address:
  • Phone: 516-376-0865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LYUDMILA PROKHIY
Title or Position: OWNER/MEMBER
Credential: M.S., ED.
Phone: 516-376-0865