Provider Demographics
NPI:1740012053
Name:MASTERMIND BEHAVIOR SERVICES NC LLC
Entity type:Organization
Organization Name:MASTERMIND BEHAVIOR SERVICES NC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAIZY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERLSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:732-813-7333
Mailing Address - Street 1:410 MONMOUTH AVE APT 100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3747
Mailing Address - Country:US
Mailing Address - Phone:732-813-7333
Mailing Address - Fax:
Practice Address - Street 1:703 QUARRY ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-2513
Practice Address - Country:US
Practice Address - Phone:732-813-7333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health