Mentalwellnessmd LLC

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

Legal business name

MENTALWELLNESSMD LLC

Practice address

93 Franklin Tpke Ste 202
Waldwick, NJ 07463-1859

Phone

(201) 987-0909

NPI assigned

Sep 7, 2022

Last updated

Jul 10, 2024By 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

Dr. Kalliopi S Nissirios, MDNPI 1073927679

Title

Owner/Director

Phone

(201) 987-0909

Specialties & licenses 2

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.

• Kalliopi S Nissirios, M.D

  • Psychiatry Physician
  • Waldwick, NJ
  • NPI 1073927679

  Multi-Specialty

  NPD Authorized official

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

{
    "created_epoch": "1662508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720569600000",
    "number": "1629799614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "93 FRANKLIN TPKE STE 202",
            "city": "WALDWICK",
            "state": "NJ",
            "postal_code": "074631859",
            "telephone_number": "201-987-0909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "93 FRANKLIN TPKE STE 202",
            "city": "WALDWICK",
            "state": "NJ",
            "postal_code": "074631859",
            "telephone_number": "201-987-0909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTALWELLNESSMD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-07",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A",
        "authorized_official_last_name": "NISSIRIOS",
        "authorized_official_first_name": "KALLIOPI",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "201-987-0909",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marian Couceiro
• Maryclaire Mena, LCSW
• Lauren Maria McCarthy, LPAT, ATR-BC
• Rachel McHale, IBCLC
• Meaningful Movement, Inc.
• Michael Moore, MD, PA
• Jessica Miglin, APN
• Beata Milutinovic, PHARMD
• Mindful Reset Counseling
• Arkady Mordkovich

• Child & Adolescent Psychiatry Physician in Waldwick, NJ
• Providers in Waldwick, NJ by specialty
• Child & Adolescent Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.