Provider Demographics
NPI:1235958281
Name:BRAINSTORM TELEPSYCH NURSING, INC.
Entity type:Organization
Organization Name:BRAINSTORM TELEPSYCH NURSING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DU
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:626-609-4712
Mailing Address - Street 1:382 N LEMON AVE # 8008
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2344
Mailing Address - Country:US
Mailing Address - Phone:626-609-4712
Mailing Address - Fax:
Practice Address - Street 1:705 N RODEO WAY
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-1479
Practice Address - Country:US
Practice Address - Phone:626-609-4712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care