Healthcare Provider Details

I. General information

NPI: 1285154583
Provider Name (Legal Business Name): MINA JOHNSON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 E 36TH ST STE 100
NEW YORK NY
10016-3389
US

IV. Provider business mailing address

36 E 36TH ST STE 100
NEW YORK NY
10016-3389
US

V. Phone/Fax

Practice location:
  • Phone: 914-401-0008
  • Fax: 914-401-0009
Mailing address:
  • Phone: 914-401-0008
  • Fax: 914-401-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF402418
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number720423-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF402418-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: