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Organization
DIVINE NEUROPSYCHIATRIC SERVICES
Active
Organization
DIVINE NEUROPSYCHIATRIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOLANLE BELLO (OWNER)
(718) 812-2655
Entity
Organization
Contact information
Practice address
25751 149TH RD, ROSEDALE, NY 11422-3022
(718) 812-2655
Mailing address
25751 149TH RD, ROSEDALE, NY 11422-3022
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/02/2020
Last updated
12/02/2020
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