MEDICARE: LUMAMIND BEHAVIORAL CENTER 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	:	1386596286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMAMIND BEHAVIORAL CENTER LLC

Provider Business Mailing Address
First Line	:	186 PATERSON AVE STE 201
Second Line	:
City	:	EAST RUTHERFORD
State	:	NJ
Zip	:	07073-1837
Country	:	US
Telephone Number	:	646-201-6645
Fax Number	:	646-201-6645

Provider Business Practice Location Address
First Line	:	411 STATE ROUTE 17
Second Line	:	SUITE 500
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604
Country	:	US
Telephone Number	:	646-201-6645
Fax Number	:	646-201-6645

Authorized Official
Title or Position	:	CEO
Name	:	GBEMISOLA ORE-OFE
Credential	:	PMHNP
Telephone Number	:	646-201-6645

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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