{
"Npi": {
"NPI": "1285399089",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HEALING MINDS PSYCHIATRY AND MENTAL WELLNESS, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "331 NEWMAN SPRINGS ROAD",
"SecondLineMailingAddress": "BUILDING 1, 4TH FLOOR, SUITE 143, MAILBOX 251",
"MailingAddressCityName": "RED BANK",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07701",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "732-934-6463",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "331 NEWMAN SPRINGS ROAD",
"SecondLinePracticeLocationAddress": "BUILDING 1, 4TH FLOOR, SUITE 143",
"PracticeLocationAddressCityName": "RED BANK",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07701",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "732-934-6463",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/05/2021",
"LastUpdateDate": "06/06/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GREISCH",
"AuthorizedOfficialFirstName": "LAURIE",
"AuthorizedOfficialMiddleName": "ELLEANORE",
"AuthorizedOfficialTitle": "FNP-C, PMHNP-BC",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "NP",
"AuthorizedOfficialTelephoneNumber": "732-934-6463",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2084P0800X",
"TaxonomyName": "Psychiatry Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}