Provider Demographics
NPI:1679285696
Name:MINDSPACE SERVICES LLC
Entity Type:Organization
Organization Name:MINDSPACE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENCHEMMAR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:347-671-1308
Mailing Address - Street 1:252 BAY RIDGE PKWY APT 4D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2456
Mailing Address - Country:US
Mailing Address - Phone:347-671-1308
Mailing Address - Fax:
Practice Address - Street 1:252 BAY RIDGE PKWY APT 4D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2456
Practice Address - Country:US
Practice Address - Phone:347-671-1308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty