# LAVENDER NEW JERSEY PSYCHIATRIC NURSE PRACTITIONER PC

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

## Provider details

- **NPI number:** 1629922950
- **Authorized official:** BRIGHID GANNON (CEO)
- **Authorized official phone:** (855) 444-7258

## Contact information

- **Practice address:** 245 5TH AVE FL 3, NEW YORK, NY 10016-8728
- **Practice address phone:** (855) 444-7258
- **Mailing address:** 22406 68TH AVE W, MOUNTLAKE TERRACE, WA 98043-2372

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/24/2026
- **Last updated:** 02/24/2026