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General NPI Number Information
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NPI Number | 1639910532
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Entity Type | Organization
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Legal Business Name | CLEARMIND NP IN PSYCHIATRY PLLC
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 55 WILLIAM ST
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-3821
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Country | US
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Telephone | 516-350-8564
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Fax |
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Provider Business Mailing Address
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Address Line | 55 WILLIAM ST
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-3821
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Country | US
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Telephone | 516-350-8564
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARINA JOSE
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Credential | PMHNP
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Telephone | 516-780-1548
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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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