Modern Mind Therapeutic Services LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

MODERN MIND THERAPEUTIC SERVICES LLC

Practice address

49 Kulick St
Clifton, NJ 07011-2375

Phone

(973) 930-9749

NPI assigned

Mar 12, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jessica Ayala, LCSWNPI 1700326238

Title

Therapist/ Owner

Phone

(973) 930-9749

Specialties & licenses 4

Addresses

Other names 1

• Modern Mind Therapy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jessica Ayala, LCSW

  • Clinical Social Worker
  • Paramus, NJ
  • NPI 1700326238
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615507200000",
    "number": "1114502929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1114 MAIN AVE UNIT 6035",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070157200",
            "telephone_number": "973-910-0900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 KULICK ST",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070112375",
            "telephone_number": "973-930-9749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN MIND THERAPEUTIC SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-12",
        "last_updated": "2021-03-12",
        "certification_date": "2021-03-12",
        "status": "A",
        "authorized_official_last_name": "AYALA",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "THERAPIST/ OWNER",
        "authorized_official_telephone_number": "973-930-9749",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Modern Mind Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ashley Lynn Mistak, LPC
• Darshanabahen J Mistry, NP
• Chana Mittel
• Mobility Care Transportation LLC
• Modern Dental Vision PC
• Modern Spine Institute LLC
• Diane Modica, MS OTR CHT
• Froilan Maac Mogol, PT
• Alaa Mohamed, LAC
• Mohammad Zamani MD LLC

• Mental Health Clinic/Center (Including Community Mental Health Center) in Clifton, NJ
• Providers in Clifton, NJ by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.