| Organization Name: | MINDHEALTH PSYCHOLOGICAL SERVICES, PLLC |
| NPI Number: | 1205239480 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KENDRA LAUREN HAVEN (OWNER) |
| Mailing Address: | 3669 Main St Suite 5 Stone Ridge |
| State: | NY US |
| Postal Code: | 124845613 |
| Phone Number: | 8457847862 |
| Fax Number: | |
| NPI Enumeration Date: | 10/02/2014 |
| NPI Last Update Date: | 10/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |