Provider Demographics
NPI:1568129278
Name:MINDFUL PATHS PSYCHIATRIC SERVICES
Entity Type:Organization
Organization Name:MINDFUL PATHS PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:F
Authorized Official - Last Name:WAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-705-5075
Mailing Address - Street 1:2400 OLD BRICK RD STE 152
Mailing Address - Street 2:C/O MATTHEW WAY MD
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-5841
Mailing Address - Country:US
Mailing Address - Phone:917-705-5075
Mailing Address - Fax:917-970-9505
Practice Address - Street 1:2400 OLD BRICK RD STE 152
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-5841
Practice Address - Country:US
Practice Address - Phone:917-705-5075
Practice Address - Fax:917-970-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty