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General NPI Number Information
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NPI Number | 1568123529
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Entity Type | Organization
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Legal Business Name | MINDFUL MOMENTOS, MARRIAGE AND FAMILY THERAPY, PLLC
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 280 MADISON AVE RM 1110
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City | NEW YORK
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State | NY
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Zip | 10016-0815
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Country | US
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Telephone | 917-626-3871
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Fax | 718-799-1457
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Provider Business Mailing Address
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Address Line | 280 MADISON AVE RM 1110
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City | NEW YORK
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State | NY
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Zip | 10016-0815
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Country | US
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Telephone | 917-626-3871
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Fax | 718-799-1457
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JOHN ANTHONY JAUREGUI JR.
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Credential | LMFT
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Telephone | 917-626-3871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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