MEDICARE: MINDSTATE HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1073326591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDSTATE HEALTH LLC

Provider Business Mailing Address
First Line	:	796 MOUNT PROSPECT AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07104-3223
Country	:	US
Telephone Number	:	908-493-5052
Fax Number	:	908-643-7240

Provider Business Practice Location Address
First Line	:	796 MOUNT PROSPECT AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07104-3223
Country	:	US
Telephone Number	:	908-493-5052
Fax Number	:	908-643-7240

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	PATRICE GUTT
Credential	:	PMHNP
Telephone Number	:	908-493-5052

Provider Enumeration Date	:	01/29/2025
Last Update Date	:	01/29/2025

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Directions to “MINDSTATE HEALTH LLC ” Practice Location

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