Provider Demographics
NPI:1588444707
Name:MINDCARE PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:MINDCARE PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATUSALEM
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:908-444-0436
Mailing Address - Street 1:3175 ROUTE 27
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824
Mailing Address - Country:US
Mailing Address - Phone:908-444-0436
Mailing Address - Fax:
Practice Address - Street 1:3175 ROUTE 27
Practice Address - Street 2:SUITE 2B
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824
Practice Address - Country:US
Practice Address - Phone:908-444-0436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty