Provider Demographics
NPI:1396628103
Name:MIND BRIDGE HEALTH NP IN PSYCHIATRY
Entity type:Organization
Organization Name:MIND BRIDGE HEALTH NP IN PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:347-424-4799
Mailing Address - Street 1:445 PARK AVE FL 990167
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2606
Mailing Address - Country:US
Mailing Address - Phone:347-424-4799
Mailing Address - Fax:347-238-3674
Practice Address - Street 1:445 PARK AVE FL 990167
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2606
Practice Address - Country:US
Practice Address - Phone:347-424-4799
Practice Address - Fax:347-238-3674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, GeropsychiatricGroup - Single Specialty