Provider Demographics
NPI:1518775139
Name:MIND GLOW SOLUTIONS
Entity type:Organization
Organization Name:MIND GLOW SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:L
Authorized Official - Last Name:AGET-TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC
Authorized Official - Phone:929-487-2874
Mailing Address - Street 1:307 W 38TH ST
Mailing Address - Street 2:FL 16, SUITE 1617
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-2913
Mailing Address - Country:US
Mailing Address - Phone:929-487-2874
Mailing Address - Fax:201-808-2957
Practice Address - Street 1:307 W 38TH ST
Practice Address - Street 2:FL 16, SUITE 1617
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-2913
Practice Address - Country:US
Practice Address - Phone:929-487-2874
Practice Address - Fax:201-808-2957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-28
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty