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Organization
ICON MENTAL HEALTH
Active
Organization
ICON MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KABIITE MUKISA (CEO)
(512) 774-3294
Entity
Organization
Contact information
Practice address
418 BROADWAY STE R, ALBANY, NY 12207-2922
(315) 840-8411
Mailing address
418 BROADWAY STE R, ALBANY, NY 12207-2922
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
04/10/2025
Last updated
04/10/2025
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