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General NPI Number Information
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NPI Number | 1053902569
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Entity Type | Organization
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Legal Business Name | DIVINE MENTAL HEALTH TREATMENT
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Dates
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Enumeration Date | 01/27/2021
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Last Update Date | 03/25/2022
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Provider Practice Location Address
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Address Line | 27 CARPENTER AVE STE 7
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City | MIDDLETOWN
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State | NY
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Zip | 10940-2401
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Country | US
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Telephone | 452-388-8538
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Fax | 646-619-4083
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Provider Business Mailing Address
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Address Line | 27 CARPENTER AVE STE 7
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City | MIDDLETOWN
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State | NY
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Zip | 10940-2401
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Country | US
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Telephone | 845-238-8853
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Fax | 646-619-4083
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTITIONER
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Name | DR. DEBRA MAYERS
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Credential | NURSE PRACTITIONER
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Telephone | 845-238-8853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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