Provider Demographics
NPI:1861234114
Name:RESILIENT MIND BEHAVIORAL HEALTH PLLC
Entity type:Organization
Organization Name:RESILIENT MIND BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH APRN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LASHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-233-3771
Mailing Address - Street 1:140 CAPTAIN THOMAS BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-5957
Mailing Address - Country:US
Mailing Address - Phone:203-233-3771
Mailing Address - Fax:
Practice Address - Street 1:140 CAPTAIN THOMAS BLVD STE 205
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-5957
Practice Address - Country:US
Practice Address - Phone:203-233-3771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty