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General NPI Number Information
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NPI Number | 1568129278
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Entity Type | Organization
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Legal Business Name | MINDFUL PATHS PSYCHIATRIC SERVICES
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Dates
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Enumeration Date | 11/17/2021
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Last Update Date | 11/17/2021
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Provider Practice Location Address
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Address Line | 2400 OLD BRICK RD STE 152
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City | GLEN ALLEN
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State | VA
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Zip | 23060-5841
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Country | US
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Telephone | 917-705-5075
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Fax | 917-970-9505
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Provider Business Mailing Address
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Address Line | 2400 OLD BRICK RD STE 152 C/O MATTHEW WAY MD
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City | GLEN ALLEN
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State | VA
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Zip | 23060-5841
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Country | US
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Telephone | 917-705-5075
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Fax | 917-970-9505
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Authorized Official
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Title or Position | OWNER / DIRECTOR
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Name | DR. MATTHEW F WAY
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Credential | MD
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Telephone | 917-705-5075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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