Provider Demographics
NPI:1891362836
Name:ADVANCED INSTITUTE FOR MIND AND EMOTIONS INC
Entity type:Organization
Organization Name:ADVANCED INSTITUTE FOR MIND AND EMOTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VALERY
Authorized Official - Middle Name:E
Authorized Official - Last Name:FRADKOV
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-497-0289
Mailing Address - Street 1:27 CANAL ST,
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07422-1203
Mailing Address - Country:US
Mailing Address - Phone:201-497-0289
Mailing Address - Fax:866-850-6432
Practice Address - Street 1:27 CANAL ST,
Practice Address - Street 2:
Practice Address - City:HIGHLAND LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07422-1203
Practice Address - Country:US
Practice Address - Phone:201-497-0289
Practice Address - Fax:866-850-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty