Mind Bridge Wellness

Primary specialty

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

Legal business name

MIND BRIDGE WELLNESS

Practice address

445 Park Avenue FL 9
90167
New York, NY 10022

Phone

(347) 300-5858

NPI assigned

Oct 25, 2024

Organization subpart

No

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

Authorized official

Name

Ms. Linda Fuller, PMHNP

Title

Owner

Phone

(347) 300-5858

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1729814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729814400000",
    "number": "1245052885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 GATES AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112214304",
            "telephone_number": "347-300-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 PARK AVENUE FL 9",
            "address_2": "90167",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10022",
            "telephone_number": "347-300-5858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND BRIDGE WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-25",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-25",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "347-300-5858",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mind Body Medical Services, PC
• Mind Bridge Health NP in Psychiatry
• Mind Care NP in Psychiatry PLLC
• Mind Clear Integrative Psychological Psychotherapy
• Mind Glow Solutions
• Mind Grove Psychology PLLC
• Mind Matters Psychology Group

• Mental Health Clinic/Center (Including Community Mental Health Center) in New York, NY
• Providers in New York, NY by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2024; 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.