Psychotherapy and Mental Wellness Group Practice, PLLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

PSYCHOTHERAPY AND MENTAL WELLNESS GROUP PRACTICE, PLLC

Practice address

10 Saint Pauls PL Apt 1L
Brooklyn, NY 11226-1363

Phone

(213) 373-4484

NPI assigned

Jul 6, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Melissa Boudin, PSY.D.NPI 1053752634

Title

Licensed Psychologist/Clinical Dir

Phone

(213) 373-4484

Specialties & licenses 3

Addresses

Practitioners 1

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

• Melissa Diane Boudin, PSY.D.

  • Clinical Psychologist
  • Pacoima, CA
  • NPI 1053752634
  NPD Authorized official

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

{
    "created_epoch": "1625529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625529600000",
    "number": "1669043196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 SAINT PAULS PL APT 1L",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112261363",
            "telephone_number": "213-373-4484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 SAINT PAULS PL APT 1L",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112261363",
            "telephone_number": "213-373-4484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOTHERAPY AND MENTAL WELLNESS GROUP PRACTICE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-06",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-06",
        "status": "A",
        "authorized_official_last_name": "BOUDIN",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST/CLINICAL DIR",
        "authorized_official_telephone_number": "213-373-4484",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2021; 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.