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General NPI Number Information
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NPI Number | 1073326591
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Entity Type | Organization
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Legal Business Name | MINDSTATE HEALTH LLC
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 796 MOUNT PROSPECT AVE
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City | NEWARK
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State | NJ
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Zip | 07104-3223
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Country | US
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Telephone | 908-493-5052
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Fax | 908-643-7240
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Provider Business Mailing Address
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Address Line | 796 MOUNT PROSPECT AVE
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City | NEWARK
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State | NJ
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Zip | 07104-3223
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Country | US
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Telephone | 908-493-5052
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Fax | 908-643-7240
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Authorized Official
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Title or Position | SOLE OWNER
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Name | PATRICE GUTT
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Credential | PMHNP
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Telephone | 908-493-5052
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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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