Provider Demographics
NPI:1215552708
Name:AMANI NIA THERAPEUTIC SERVICES PLLC
Entity Type:Organization
Organization Name:AMANI NIA THERAPEUTIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AKEERA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-807-5005
Mailing Address - Street 1:133 MAIN ST APT 5
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4650
Mailing Address - Country:US
Mailing Address - Phone:631-807-5005
Mailing Address - Fax:
Practice Address - Street 1:64 WALL ST STE 306
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3403
Practice Address - Country:US
Practice Address - Phone:203-674-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)