Provider Demographics
NPI:1952831125
Name:MINDFULNESS PSYCHOLOGICAL SERVICES PC
Entity Type:Organization
Organization Name:MINDFULNESS PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:LIZETTE
Authorized Official - Last Name:SALVIA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:347-449-0165
Mailing Address - Street 1:5608 VAN CLEEF ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-4026
Mailing Address - Country:US
Mailing Address - Phone:347-449-0165
Mailing Address - Fax:
Practice Address - Street 1:7050 AUSTIN ST STE 108
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4746
Practice Address - Country:US
Practice Address - Phone:347-449-0165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty