=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861066813
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARISE WELLNESS PSYCHOLOGY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2021
-----------------------------------------------------
Last Update Date | 05/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 WILLIS AVE # 1
-----------------------------------------------------
City | MINEOLA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11501-4408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-433-5382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 WILLIS AVE # 1
-----------------------------------------------------
City | MINEOLA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11501-4408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-433-5382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. SADIA R. CHAUDHURY
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 917-251-3557
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------