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General NPI Number Information
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NPI Number | 1174380141
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Entity Type | Organization
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Legal Business Name | MINDFUL CARE NP IN PSYCHIATRY AND NP IN ADULT HEALTH PC
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Dates
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Enumeration Date | 03/05/2024
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 571 E 19TH ST APT 6B
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City | BROOKLYN
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State | NY
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Zip | 11226-7674
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Country | US
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Telephone | 929-322-1924
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Fax |
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Provider Business Mailing Address
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Address Line | 571 E 19TH ST APT 6B
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City | BROOKLYN
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State | NY
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Zip | 11226-7674
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Country | US
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Telephone | 929-274-5188
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Fax | 929-274-5330
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Authorized Official
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Title or Position | OWNER
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Name | ERICKA DEADWYLER-GOURGUE
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Credential | NP
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Telephone | 929-274-5188
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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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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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