NPIMap

Organization Active NPI

Mind Rejuvenation Therapy

  • Clinical Social Worker
  • New York, NY
National Provider Identifier
1295299170
Registry record updated Jan 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MIND REJUVENATION THERAPY
Practice address
57 Saint Marks PL
New York, NY 10003-7902
Phone
(347) 620-3477
NPI assigned
Jan 25, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2019

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

Authorized official

Name
Jacklyn Krol
Title
Psychotherapist/Owner
Phone
(347) 620-3477

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

57 Saint Marks PL
New York, NY 10003-7902

Mailing address

57 Saint Marks PL
New York, NY 10003-7902

Other names 1

  • Mind Rejuvenation Therapy Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1548374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548374400000",
    "number": "1295299170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 SAINT MARKS PL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100037902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 SAINT MARKS PL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100037902",
            "telephone_number": "347-620-3477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND REJUVENATION THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-25",
        "last_updated": "2019-01-25",
        "status": "A",
        "authorized_official_last_name": "KROL",
        "authorized_official_first_name": "JACKLYN",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST/OWNER",
        "authorized_official_telephone_number": "347-620-3477"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mind Rejuvenation Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2019; 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.