The Rejuvenation Space LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

THE REJUVENATION SPACE LLC

Practice address

230 40TH St
Irvington, NJ 07111-1149

Phone

(646) 633-5595

NPI assigned

Apr 8, 2020

Organization subpart

No

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

Authorized official

Name

Mrs. Chrystal Renee Allen, LICENSED COUNSELORNPI 1235581448

Title

Business Owner

Phone

(646) 633-5595

Specialties & licenses 1

Addresses

Electronic endpoints 3

Practitioners 1

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

• Chrystal Renee Allen, LMHC, NCC

  • Mental Health Counselor
  • Hastings on Hudson, NY
  • NPI 1235581448
  NPD Authorized official

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

{
    "created_epoch": "1586304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586908800000",
    "number": "1386273571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 40TH ST",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "071111149",
            "telephone_number": "646-633-5595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 40TH ST",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "071111149",
            "telephone_number": "646-633-5595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE REJUVENATION SPACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-08",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "CHRYSTAL",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "BUSINESS OWNER",
        "authorized_official_telephone_number": "646-633-5595",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LICENSED COUNSELOR"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "laptop",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "230 40th St",
            "city": "Irvington",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "071111149",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "desktop",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "230 40th St",
            "city": "Irvington",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "071111149",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "smartphone",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "230 40th St",
            "city": "Irvington",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "071111149",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Counselor in Irvington, NJ
• Providers in Irvington, NJ by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; 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.