Healthcare Provider Details

I. General information

NPI: 1932011749
Provider Name (Legal Business Name): MENTALOGY WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 N COLE AVE UNIT 312
SPRING VALLEY NY
10977-4740
US

IV. Provider business mailing address

59 N COLE AVE UNIT 312
SPRING VALLEY NY
10977-4740
US

V. Phone/Fax

Practice location:
  • Phone: 973-370-4000
  • Fax:
Mailing address:
  • Phone: 973-370-4000
  • 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

VIII. Authorized Official

Name: MR. MAGDY MAHMOUD
Title or Position: DIRECTOR
Credential: MR.
Phone: 973-370-4000