Provider Demographics
NPI:1932064078
Name:MINDFULKID CHILD PSYCHIATRY PLLC
Entity type:Organization
Organization Name:MINDFULKID CHILD PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFRANCISCI LIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-460-7836
Mailing Address - Street 1:61 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-4870
Mailing Address - Country:US
Mailing Address - Phone:631-460-7836
Mailing Address - Fax:631-209-5030
Practice Address - Street 1:61 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-4870
Practice Address - Country:US
Practice Address - Phone:631-460-7836
Practice Address - Fax:631-209-5030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-22
Last Update Date:2025-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)