Provider Demographics
NPI:1144880550
Name:LWM MENTAL HEALTH SPECIALIST LLC
Entity type:Organization
Organization Name:LWM MENTAL HEALTH SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREE
Authorized Official - Middle Name:WOLIN
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-399-6852
Mailing Address - Street 1:34 PLAZA STREET EAST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34 PLAZA STREET EAST
Practice Address - Street 2:SUITE 102
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238
Practice Address - Country:US
Practice Address - Phone:718-399-6852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LWM MENTAL HEALTH SPECIALIST LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02816544Medicaid