Provider Demographics
NPI:1881921500
Name:MIND FLEX LLC
Entity type:Organization
Organization Name:MIND FLEX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PICARIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:610-812-4571
Mailing Address - Street 1:254 RADCLIFFE ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-5014
Mailing Address - Country:US
Mailing Address - Phone:610-812-4730
Mailing Address - Fax:
Practice Address - Street 1:254 RADCLIFFE ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-5014
Practice Address - Country:US
Practice Address - Phone:610-812-4730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS01634103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA144930ZB1SMedicare PIN