Organization
AGELESS MIND NY INC
Active
Other names
Ageless Mind NY
Organization subpart
No
Provider details
NPI number
Authorized official
IZABELLE REYHANIAN HAKIM LCSW, EMPA (OWNER)
(516) 726-0301
Entity
Organization
Contact information
Practice address
55 NORTHERN BLVD STE 406, GREAT NECK, NY 11021-4058
(516) 726-0301
Mailing address
55 NORTHERN BLVD STE 406, GREAT NECK, NY 11021-4058
(516) 726-0301
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
078204-1
NY
Other
Enumeration date
09/05/2018
Last updated
01/10/2019
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