Provider Demographics
NPI:1265020903
Name:INDIVIDUAL PATH, LLC
Entity Type:Organization
Organization Name:INDIVIDUAL PATH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVENIDE
Authorized Official - Middle Name:JAMILHA
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:718-730-3469
Mailing Address - Street 1:201 CROWN ST APT 4J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-2139
Mailing Address - Country:US
Mailing Address - Phone:718-730-3469
Mailing Address - Fax:
Practice Address - Street 1:201 CROWN ST APT 4J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-2139
Practice Address - Country:US
Practice Address - Phone:718-730-3469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty