1215759204 NPI number — HARVEST MIND NP IN PSYCHIATRY PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215759204 NPI number — HARVEST MIND NP IN PSYCHIATRY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARVEST MIND NP IN PSYCHIATRY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215759204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 RELLA BOULEVARD
Provider Second Line Business Mailing Address:
SUITE 207-137
Provider Business Mailing Address City Name:
MONTEBELLO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-991-7285
Provider Business Mailing Address Fax Number:
866-487-9572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 RELLA BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 207-137
Provider Business Practice Location Address City Name:
MONTEBELLO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-991-7285
Provider Business Practice Location Address Fax Number:
866-487-9572
Provider Enumeration Date:
10/30/2024

Additional Information

Authorized Official

Authorized Official Last Name:
VASSOR
Authorized Official First Name:
SAMANTHA
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCH NURSE PRACTITIONER, OWNER
Authorized Official Telephone Number:
646-991-7285

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com