Healthcare Provider Details

I. General information

NPI: 1043953490
Provider Name (Legal Business Name): NIIVANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MADISON AVE STE 1202
NEW YORK NY
10022-3301
US

IV. Provider business mailing address

555 MADISON AVE STE 1202
NEW YORK NY
10022-3301
US

V. Phone/Fax

Practice location:
  • Phone: 917-912-0051
  • Fax:
Mailing address:
  • Phone: 917-912-0051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN WILLIAMS
Title or Position: CEO
Credential:
Phone: 917-912-0051