Provider Demographics
NPI:1942067541
Name:MENTAL MAKEUP PSYCHIATRY AND COUNSELING
Entity Type:Organization
Organization Name:MENTAL MAKEUP PSYCHIATRY AND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEOGUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-463-8636
Mailing Address - Street 1:2207 SCHINDLER DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3754
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2207 SCHINDLER DR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3754
Practice Address - Country:US
Practice Address - Phone:201-463-8638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty