Mind Restoration LLC

Primary specialty

Neurodevelopmental Disabilities PhysicianTaxonomy code 2084P0005X

Legal business name

MIND RESTORATION LLC

Practice address

418 Broadway Ste Y
Albany, NY 12207-2922

Phone

(833) 294-6969

NPI assigned

Nov 7, 2023

Last updated

Nov 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Latisha MyrieNPI 1679225502

Title

Ceo

Phone

(833) 294-6969

Specialties & licenses 4

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Latisha Myrie

  • Psychiatric/Mental Health Nurse Practitioner
  • Bronx, NY
  • NPI 1679225502

  Multi-Specialty

  NPD Authorized official

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

{
    "created_epoch": "1699315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699315200000",
    "number": "1336912732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "418 BROADWAY STE Y",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122072922",
            "telephone_number": "833-294-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 BROADWAY STE Y",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122072922",
            "telephone_number": "833-294-6969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND RESTORATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-07",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-06",
        "status": "A",
        "authorized_official_last_name": "MYRIE",
        "authorized_official_first_name": "LATISHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "833-294-6969"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0005X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurodevelopmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Louise Alexandra Mills
• Kevin Milone, DO
• Jung-Yun Min, PHD
• Rhonda Mincolla, CRNA
• James Ernest Mincy, M.D.
• Mindful Insights Mental Health Counseling PLLC
• Mindful Living Social Work, LCSW, LLC
• Mindful Moments Mental Health Counseling Service, PLLC
• Mindful Speech and Learning LLC
• Bridget M Mineau, R.N.

• Neurodevelopmental Disabilities Physician in Albany, NY
• Providers in Albany, NY by specialty
• Neurodevelopmental Disabilities Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; 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.