Healthcare Provider Details

I. General information

NPI: 1043366248
Provider Name (Legal Business Name): EMPOWERING MINDS THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 BUCKINGHAM DR
HOLBROOK NY
11741-2880
US

IV. Provider business mailing address

38 BUCKINGHAM DR
HOLBROOK NY
11741-2880
US

V. Phone/Fax

Practice location:
  • Phone: 631-738-0310
  • Fax: 631-738-0311
Mailing address:
  • Phone: 631-738-0310
  • Fax: 631-738-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number32070
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNY

VIII. Authorized Official

Name: MR. VINCENT JOSEPH LOPRETO
Title or Position: VICE PRESIDENT - CFO
Credential:
Phone: 631-738-0310