MEDICARE: REAL MIND MENTAL HEALTH COUNSELING P.C.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1790635647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REAL MIND MENTAL HEALTH COUNSELING P.C.

Provider Business Mailing Address
First Line	:	96 SIMONSON PL
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-1816
Country	:	US
Telephone Number	:	347-681-0419
Fax Number	:

Provider Business Practice Location Address
First Line	:	96 SIMONSON PL
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-1816
Country	:	US
Telephone Number	:	347-681-0419
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MRS. GLAD EFFY UKO-IMA
Credential	:	MA, LMHC
Telephone Number	:	347-681-0419

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	01/30/2026

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