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General NPI Number Information
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NPI Number | 1225980832
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Entity Type | Organization
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Legal Business Name | MINDS WIDE OPEN PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 02/14/2026
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Last Update Date | 02/14/2026
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Provider Practice Location Address
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Address Line | 529 HELENA AVE
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City | WYCKOFF
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State | NJ
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Zip | 07481-1220
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Country | US
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Telephone | 201-416-9622
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 131
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City | MIDLAND PARK
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State | NJ
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Zip | 07432-0131
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Country | US
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Telephone | 201-416-9622
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | ERIKA KAO
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Credential | LCSW
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Telephone | 201-416-9622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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