1790635647 NPI number — REAL MIND MENTAL HEALTH COUNSELING P.C.

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 1790635647 NPI number — REAL MIND MENTAL HEALTH COUNSELING P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REAL MIND MENTAL HEALTH COUNSELING P.C.
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:
1790635647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
96 SIMONSON PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10302-1816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-681-0419
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
96 SIMONSON PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10302-1816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-681-0419
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2026

Additional Information

Authorized Official

Authorized Official Last Name:
UKO-IMA
Authorized Official First Name:
GLAD
Authorized Official Middle Name:
EFFY
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
347-681-0419

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; 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