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General NPI Number Information
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NPI Number | 1912590977
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Entity Type | Organization
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Legal Business Name | LIVING WELL MINDFULLY, INC
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Dates
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Enumeration Date | 02/19/2021
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 358 VETERANS MEMORIAL HWY STE 12
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City | COMMACK
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State | NY
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Zip | 11725-4326
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Country | US
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Telephone | 631-268-4148
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 211
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City | ISLIP
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State | NY
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Zip | 11751-0211
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELISSA M SCHROEDER
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Credential | PSYD
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Telephone | 631-268-4148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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