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General NPI Number Information
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NPI Number | 1144939729
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Entity Type | Organization
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Legal Business Name | MIND MATRIX
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Dates
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Enumeration Date | 11/22/2022
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 5918 MAIN ST STE 105
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City | MAYS LANDING
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State | NJ
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Zip | 08330-1721
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Country | US
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Telephone | 609-908-4790
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Fax | 609-739-8843
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Provider Business Mailing Address
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Address Line | 5918 MAIN ST STE 105
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City | MAYS LANDING
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State | NJ
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Zip | 08330-1721
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Country | US
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Telephone | 609-908-4790
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Fax | 609-739-8843
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Authorized Official
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Title or Position | OWNER
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Name | LINDA BENNER
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Credential | PMHNP
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Telephone | 609-908-4790
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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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