Healthcare Provider Details

I. General information

NPI: 1508629494
Provider Name (Legal Business Name): TALKSPACE WA PSYCHIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2578 BROADWAY # 607
NEW YORK NY
10025-5642
US

IV. Provider business mailing address

PO BOX 659
PORTSMOUTH NH
03802-0659
US

V. Phone/Fax

Practice location:
  • Phone: 212-284-7206
  • Fax:
Mailing address:
  • Phone: 212-284-7206
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: NIKOLE BENDERS-HADI
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 212-284-7206