Provider Demographics
NPI:1659932937
Name:CARBON MINDS LLC
Entity Type:Organization
Organization Name:CARBON MINDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRELONGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-755-5214
Mailing Address - Street 1:95 DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3215
Mailing Address - Country:US
Mailing Address - Phone:347-755-5214
Mailing Address - Fax:
Practice Address - Street 1:95 DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3215
Practice Address - Country:US
Practice Address - Phone:347-755-5214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty