Ageless Mind Ny Inc

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

078204-1 Issued in NY

Legal business name

AGELESS MIND NY INC

Doing business as

Ageless Mind NY

Practice address

55 Northern Blvd Ste 406
Great Neck, NY 11021-4058

Phone

(516) 726-0301

NPI assigned

Sep 5, 2018

Last updated

Jan 10, 2019By 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

Izabelle Reyhanian Hakim, LCSW, EMPANPI 1205149689

Title

Owner

Phone

(516) 726-0301

Specialties & licenses 1

Addresses

Other names 1

• Ageless Mind NY Doing business as

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.

• Izabelle Reyhanian Hakim, LCSW

  • Clinical Social Worker
  • Great Neck, NY
  • NPI 1205149689
  NPD Authorized official

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

{
    "created_epoch": "1536105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547078400000",
    "number": "1649752767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 NORTHERN BLVD STE 406",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214058",
            "telephone_number": "516-726-0301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 NORTHERN BLVD STE 406",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214058",
            "telephone_number": "516-726-0301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGELESS MIND NY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-05",
        "last_updated": "2019-01-10",
        "status": "A",
        "authorized_official_last_name": "HAKIM",
        "authorized_official_first_name": "IZABELLE",
        "authorized_official_middle_name": "REYHANIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-726-0301",
        "authorized_official_credential": "LCSW, EMPA"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "078204-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ageless Mind NY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Health Counselor in Great Neck, NY
• Providers in Great Neck, NY by specialty
• Mental Health Counselor in New York

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