Provider Demographics
NPI: | 1568150837 |
---|---|
Name: | NEW MIND |
Entity Type: | Organization |
Organization Name: | NEW MIND |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ARMIDIA |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | OSORIO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 786-991-8917 |
Mailing Address - Street 1: | 904 E 24TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | HIALEAH |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33013-4233 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 786-991-8917 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 904 E 24TH ST |
Practice Address - Street 2: | |
Practice Address - City: | HIALEAH |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33013-4233 |
Practice Address - Country: | US |
Practice Address - Phone: | 786-991-8917 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-04-25 |
Last Update Date: | 2023-04-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Single Specialty |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Single Specialty |