Healthcare Provider Details

I. General information

NPI: 1255944377
Provider Name (Legal Business Name): MINDWELL PSYCHOLOGY, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 DANBY RD STE 202F
ITHACA NY
14850-5714
US

IV. Provider business mailing address

950 DANBY RD STE 202
ITHACA NY
14850-5714
US

V. Phone/Fax

Practice location:
  • Phone: 802-578-4379
  • Fax:
Mailing address:
  • Phone: 607-260-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. AARON RAKOW
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 802-578-4379