Provider Demographics
NPI:1376983056
Name:MENDING OUR MINDS, INC
Entity Type:Organization
Organization Name:MENDING OUR MINDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAUNDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN-BENN
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:973-744-1192
Mailing Address - Street 1:50 CHURCH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2772
Mailing Address - Country:US
Mailing Address - Phone:973-744-1192
Mailing Address - Fax:973-676-5801
Practice Address - Street 1:50 CHURCH ST
Practice Address - Street 2:STE 101
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2772
Practice Address - Country:US
Practice Address - Phone:973-744-1192
Practice Address - Fax:973-676-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC06850500364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty