=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952108367
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIND MATTERS PSYCHOLOGY GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2025
-----------------------------------------------------
Last Update Date | 02/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 575 W END AVE SUITE GR A & B
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10024-2711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-300-1537
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 522 W END AVE APT 2B
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10024-3211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-342-4393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER/CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. MOUGEH YASAI
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 646-820-5816
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------