Provider Demographics
NPI:1568123529
Name:MINDFUL MOMENTOS, MARRIAGE AND FAMILY THERAPY, PLLC
Entity Type:Organization
Organization Name:MINDFUL MOMENTOS, MARRIAGE AND FAMILY THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:JAUREGUI
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMFT
Authorized Official - Phone:917-626-3871
Mailing Address - Street 1:280 MADISON AVE RM 1110
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0815
Mailing Address - Country:US
Mailing Address - Phone:917-626-3871
Mailing Address - Fax:718-799-1457
Practice Address - Street 1:280 MADISON AVE RM 1110
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0815
Practice Address - Country:US
Practice Address - Phone:917-626-3871
Practice Address - Fax:718-799-1457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty