=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568061935
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STABLE MINDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2020
-----------------------------------------------------
Last Update Date | 10/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75 RAILROAD PL
-----------------------------------------------------
City | SARATOGA SPRINGS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12866-2124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-441-2574
-----------------------------------------------------
Fax | 518-244-8495
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 RAILROAD PL APT 402
-----------------------------------------------------
City | SARATOGA SPRINGS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12866-2242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-441-2574
-----------------------------------------------------
Fax | 518-244-8495
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ELIZABETH JANE MASTRO
-----------------------------------------------------
Credential | APRN, MSN, NPP
-----------------------------------------------------
Telephone | 518-441-2574
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------