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General NPI Number Information
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NPI Number | 1417879651
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Entity Type | Organization
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Legal Business Name | MIND MATTERS-NURSE PRACTITIONER IN PSYCHIATRY, PLLC
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Dates
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Enumeration Date | 07/28/2026
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Last Update Date | 07/28/2026
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Provider Practice Location Address
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Address Line | 1360 HYLAN BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10305-1922
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Country | US
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Telephone | 347-766-2155
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Fax | 949-909-2221
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Provider Business Mailing Address
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Address Line | 1885 HYLAN BLVD STE 1055
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City | STATEN ISLAND
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State | NY
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Zip | 10305-2110
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Country | US
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Telephone | 347-766-2155
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Fax | 949-909-2221
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Authorized Official
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Title or Position | OWNER/MANAGING MEMBER
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Name | TARA COURTNEY CALLOW
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Credential | PMHNP
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Telephone | 347-766-2155
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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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