Provider Demographics
NPI:1063114379
Name:THERAPY FOR MINDFUL EVOLUTION NEW YORK LLC
Entity type:Organization
Organization Name:THERAPY FOR MINDFUL EVOLUTION NEW YORK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDALIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:FADUL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:914-979-1384
Mailing Address - Street 1:41 OXFORD LN
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10926-3008
Mailing Address - Country:US
Mailing Address - Phone:845-401-6215
Mailing Address - Fax:
Practice Address - Street 1:41 OXFORD LN
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:NY
Practice Address - Zip Code:10926-3008
Practice Address - Country:US
Practice Address - Phone:845-401-6215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center