| Organization Name: | MINDCARE AGENCY PC |
| NPI Number: | 1730557018 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | OMAR FARUK (CEO) |
| Mailing Address: | 125 Liberty St Suite 205 Springfield |
| State: | MA US |
| Postal Code: | 011031114 |
| Phone Number: | 4132717136 |
| Fax Number: | 4132717137 |
| NPI Enumeration Date: | 09/03/2015 |
| NPI Last Update Date: | 11/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084A0401X |
| License Number: | 223674 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |