Provider Demographics
NPI:1215759204
Name:HARVEST MIND NP IN PSYCHIATRY PLLC
Entity type:Organization
Organization Name:HARVEST MIND NP IN PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCH NURSE PRACTITIONER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VASSOR
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:646-991-7285
Mailing Address - Street 1:400 RELLA BOULEVARD
Mailing Address - Street 2:SUITE 207-137
Mailing Address - City:MONTEBELLO
Mailing Address - State:NY
Mailing Address - Zip Code:10901
Mailing Address - Country:US
Mailing Address - Phone:646-991-7285
Mailing Address - Fax:646-914-2533
Practice Address - Street 1:400 RELLA BOULEVARD
Practice Address - Street 2:SUITE 207-137
Practice Address - City:MONTEBELLO
Practice Address - State:NY
Practice Address - Zip Code:10901
Practice Address - Country:US
Practice Address - Phone:646-991-7285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty