# MENTALWELLNESSMD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629799614
- **Authorized official:** DR. KALLIOPI S NISSIRIOS MD (OWNER/DIRECTOR)
- **Authorized official phone:** (201) 987-0909

## Contact information

- **Practice address:** 93 FRANKLIN TPKE STE 202, WALDWICK, NJ 07463-1859
- **Practice address phone:** (201) 987-0909
- **Mailing address:** 93 FRANKLIN TPKE STE 202, WALDWICK, NJ 07463-1859
- **Mailing address phone:** (201) 987-0909

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/07/2022
- **Last updated:** 07/10/2024