Provider Demographics
NPI:1932584547
Name:A HEALTHY MIND
Entity Type:Organization
Organization Name:A HEALTHY MIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TOBECHUKWU
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOUDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-524-0591
Mailing Address - Street 1:852 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:VAUXHALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07088-1204
Mailing Address - Country:US
Mailing Address - Phone:973-524-0591
Mailing Address - Fax:
Practice Address - Street 1:2130 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3725
Practice Address - Country:US
Practice Address - Phone:973-524-0591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08739900261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1669603387Medicare PIN