Provider Demographics
NPI:1295326866
Name:EP MINDFUL PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:EP MINDFUL PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:PICON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-859-3417
Mailing Address - Street 1:5230 TUCKERMAN LN APT 820
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3860
Mailing Address - Country:US
Mailing Address - Phone:917-859-3417
Mailing Address - Fax:
Practice Address - Street 1:5230 TUCKERMAN LN APT 820
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3860
Practice Address - Country:US
Practice Address - Phone:917-859-3417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health