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General NPI Number Information
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NPI Number | 1588196273
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Entity Type | Organization
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Legal Business Name | MIND BODY PSYCHIATRY
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Dates
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Enumeration Date | 03/31/2017
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Last Update Date | 03/31/2017
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Provider Practice Location Address
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Address Line | 49 8TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11217-3901
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Country | US
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Telephone | 646-606-2663
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Fax |
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Provider Business Mailing Address
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Address Line | 49 8TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11217-3901
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Country | US
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Telephone | 646-606-2663
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BEATA LEWIS
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Credential | MD
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Telephone | 646-606-2663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 098006
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 084128
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 285499
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 246720
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License Number State | NY
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