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General NPI Number Information
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NPI Number | 1396628103
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Entity Type | Organization
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Legal Business Name | MIND BRIDGE HEALTH NP IN PSYCHIATRY
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 445 PARK AVE FL 990167
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City | NEW YORK
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State | NY
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Zip | 10022-2606
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Country | US
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Telephone | 347-424-4799
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Fax | 347-238-3674
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Provider Business Mailing Address
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Address Line | 445 PARK AVE FL 990167
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City | NEW YORK
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State | NY
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Zip | 10022-2606
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Country | US
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Telephone | 347-424-4799
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Fax | 347-238-3674
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Authorized Official
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Title or Position | OWNER
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Name | LINDA FULLER
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Credential | PMHNP
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Telephone | 347-424-4799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0813X
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Taxonomy Name | Geropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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