MEDICARE: AFFECT THERAPEUTICS, INC.

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1528878832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFECT THERAPEUTICS, INC.

Provider Business Mailing Address
First Line	:	1640 BORO PL FL 4
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-3627
Country	:	US
Telephone Number	:	845-769-8758
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 RICHLAND AVE STE 105
Second Line	:
City	:	ATHENS
State	:	OH
Zip	:	45701-3700
Country	:	US
Telephone Number	:	845-769-8758
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF COMPLIANCE
Name	:	KARLA RENEE MULLINGS
Credential	:
Telephone Number	:	845-768-8758

Provider Enumeration Date	:	01/09/2025
Last Update Date	:	01/09/2025

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