MEDICARE: INCLUSIVE MINDS FOUNDATION CO.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103TC0700X	Clinical Psychologist
3	2084P0800X	Psychiatry Physician
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1306713243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INCLUSIVE MINDS FOUNDATION CO.

Provider Business Mailing Address
First Line	:	167 MADISON AVE STE 205 #4667
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016
Country	:	US
Telephone Number	:	929-223-6825
Fax Number	:

Provider Business Practice Location Address
First Line	:	254 COMMERCIAL ST STE 245B
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-4664
Country	:	US
Telephone Number	:	929-564-3880
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAHIMEH ANDALIBIAN
Credential	:	PSY.D.
Telephone Number	:	929-564-3880

Provider Enumeration Date	:	10/23/2025
Last Update Date	:	02/10/2026

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