Organization
MINDWELL PSYCHOLOGICAL ASSESSMENT, LLP
Active
Parent organization
MINDWELL CENTER, LLP
Other names
MindWell Psychological Assessment, LLP
Organization subpart
Yes
Provider details
NPI number
Legal business name
MINDWELL CENTER, LLP
Authorized official
DR. AARON RAKOW PHD (EXECUTIVE DIRECTOR)
(607) 260-3100
Entity
Organization
Contact information
Practice address
15 CORNELL RD STE 2, LATHAM, NY 12110-1490
(607) 260-3100
Mailing address
950 DANBY RD STE 202, ITHACA, NY 14850-5714
(607) 260-3100
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992316400
—
NY
Enumeration date
06/16/2022
Last updated
06/16/2022
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