Provider Demographics
NPI:1629799614
Name:MENTALHEALTHANDWELLNESSMD
Entity Type:Organization
Organization Name:MENTALHEALTHANDWELLNESSMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KALLIOPI
Authorized Official - Middle Name:S
Authorized Official - Last Name:NISSIRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-987-0909
Mailing Address - Street 1:93 FRANKLIN TPKE STE 202
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1859
Mailing Address - Country:US
Mailing Address - Phone:201-987-0909
Mailing Address - Fax:
Practice Address - Street 1:93 FRANKLIN TPKE STE 202
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1859
Practice Address - Country:US
Practice Address - Phone:201-987-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty