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General NPI Number Information
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NPI Number | 1063286417
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Entity Type | Organization
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Legal Business Name | MIND WELLNESS PSYCHOLOGY PLLC
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Dates
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Enumeration Date | 11/07/2023
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 444 E 82ND ST APT 9T
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City | NEW YORK
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State | NY
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Zip | 10028-5912
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Country | US
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Telephone | 917-685-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 444 E 82ND ST APT 9T
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City | NEW YORK
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State | NY
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Zip | 10028-5912
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Country | US
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Telephone | 917-685-9090
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | KRISTY ANGEN
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Credential | PSY.D.
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Telephone | 917-685-9090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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