Provider Demographics
NPI:1063286417
Name:MIND WELLNESS PSYCHOLOGY PLLC
Entity type:Organization
Organization Name:MIND WELLNESS PSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:917-685-9090
Mailing Address - Street 1:444 E 82ND ST APT 9T
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-5912
Mailing Address - Country:US
Mailing Address - Phone:917-685-9090
Mailing Address - Fax:
Practice Address - Street 1:444 E 82ND ST APT 9T
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-5912
Practice Address - Country:US
Practice Address - Phone:917-685-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty