Provider Demographics
NPI:1972375814
Name:MINDSET PSYCHIATRY LLC
Entity Type:Organization
Organization Name:MINDSET PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:KETAKI
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:203-981-8614
Mailing Address - Street 1:1234 SUMMER ST STE 302
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5510
Mailing Address - Country:US
Mailing Address - Phone:203-981-8614
Mailing Address - Fax:
Practice Address - Street 1:1234 SUMMER ST STE 302
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5510
Practice Address - Country:US
Practice Address - Phone:203-981-8614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty