Healthcare Provider Details

I. General information

NPI: 1225826985
Provider Name (Legal Business Name): CLEAR MIND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MAMARONECK AVE STE 201
WHITE PLAINS NY
10601-5315
US

IV. Provider business mailing address

200 MAMARONECK AVE STE 201
WHITE PLAINS NY
10601-5315
US

V. Phone/Fax

Practice location:
  • Phone: 914-639-3100
  • Fax:
Mailing address:
  • Phone:
  • 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: MARIN WITRIOL
Title or Position: CEO
Credential:
Phone: 718-813-2404