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General NPI Number Information
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NPI Number | 1205239480
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Entity Type | Organization
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Legal Business Name | MINDHEALTH PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 3669 MAIN ST SUITE 5
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City | STONE RIDGE
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State | NY
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Zip | 12484-5613
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Country | US
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Telephone | 845-784-7862
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Fax |
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Provider Business Mailing Address
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Address Line | 3669 MAIN ST STE 5 P.O. BOX 894
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City | STONE RIDGE
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State | NY
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Zip | 12484-5613
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Country | US
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Telephone | 845-784-7862
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENDRA LAUREN HAVEN
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Credential | PH.D.
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Telephone | 845-784-7862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State | NY
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