Mindspace Clinic

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

MINDSPACE CLINIC

Practice address

137 Evegreen Place
Suite 1B
East Orange, NJ 07018-2005

Phone

(201) 407-0702

NPI assigned

Aug 11, 2022

Organization subpart

No

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

Authorized official

Name

Lilian Kordie, NPANPI 1720460108

Title

Provider

Phone

(201) 407-0702

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

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

• Lilian Kordie

  • Psychiatric/Mental Health Nurse Practitioner
  • East Orange, NJ
  • NPI 1720460108
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1660176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660176000000",
    "number": "1134857642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "137 EVEGREEN PLACE",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "070182005",
            "telephone_number": "201-407-0702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "137 EVEGREEN PLACE",
            "address_2": "SUITE 1B",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "070182005",
            "telephone_number": "201-407-0702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDSPACE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-11",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-08",
        "status": "A",
        "authorized_official_last_name": "KORDIE",
        "authorized_official_first_name": "LILIAN",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "201-407-0702",
        "authorized_official_credential": "NPA"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marilyn Ann Miller, M.D.
• Malineda Mandy Millionard, MS, ABA
• Quandra Milton, LSW
• Mind and Ability
• Mind and Ability
• Miracle Mental Health Care Services LLC
• Alvan E Mitchell, DMD
• Thomas P Mitchell
• Siuyin Mo, RPH
• Danielle Mobley

• Psychiatric/Mental Health Nurse Practitioner in East Orange, NJ
• Providers in East Orange, NJ by specialty
• Psychiatric/Mental Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.