Healthcare Provider Details

I. General information

NPI: 1164943676
Provider Name (Legal Business Name): STATE OF MIND HEALTH PSYCHIATRY NP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 HOLLAND LN
MONSEY NY
10952-1323
US

IV. Provider business mailing address

27 HOLLAND LN
MONSEY NY
10952-1323
US

V. Phone/Fax

Practice location:
  • Phone: 845-535-1530
  • Fax:
Mailing address:
  • Phone: 845-535-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NECHAMA KELLER-SABEL
Title or Position: MANAGER
Credential:
Phone: 845-535-1530