MEDICARE: MIND CARE NP IN PSYCHIATRY PLLC

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	:	1184554057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND CARE NP IN PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	42 BROADWAY STE 12-652
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10004-1617
Country	:	US
Telephone Number	:	347-301-6457
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 BROADWAY STE 12-652
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10004-1617
Country	:	US
Telephone Number	:	347-301-6457
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LATIFAT FOLAJAIYE
Credential	:	PMHNP
Telephone Number	:	347-301-6457

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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