Healthcare Provider Details

I. General information

NPI: 1922888460
Provider Name (Legal Business Name): LIFT UP LIVE WELL MENTAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 5TH AVE RM 704
NEW YORK NY
10001-4527
US

IV. Provider business mailing address

99 MAIN ST STE 216
NYACK NY
10960-3109
US

V. Phone/Fax

Practice location:
  • Phone: 212-918-4488
  • Fax:
Mailing address:
  • Phone: 929-486-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NERISA BRYAN
Title or Position: OWNER/APN
Credential: APN
Phone: 929-486-0990