Provider Demographics
NPI:1982310405
Name:MINDSITE HEALTH LLC
Entity Type:Organization
Organization Name:MINDSITE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:NWOUS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, CRNP-PMH
Authorized Official - Phone:443-230-4050
Mailing Address - Street 1:6755 BUSINESS PKWY STE 109
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6856
Mailing Address - Country:US
Mailing Address - Phone:443-230-4050
Mailing Address - Fax:
Practice Address - Street 1:6755 BUSINESS PKWY STE 109
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6856
Practice Address - Country:US
Practice Address - Phone:443-230-4050
Practice Address - Fax:609-710-1599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty