Provider Demographics
NPI:1902430556
Name:MIND AND BODY WELLNESS SERVICES LLC
Entity type:Organization
Organization Name:MIND AND BODY WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGARD
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:DANIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:347-453-1601
Mailing Address - Street 1:1355 GENOVESE LN
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-7002
Mailing Address - Country:US
Mailing Address - Phone:347-453-1601
Mailing Address - Fax:
Practice Address - Street 1:302 5TH AVE STE 804
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3604
Practice Address - Country:US
Practice Address - Phone:347-453-1601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-22
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty