Provider Demographics
NPI:1053167825
Name:AUSPICIOUS MENTAL HEALTH LLC
Entity type:Organization
Organization Name:AUSPICIOUS MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:OLANIKE
Authorized Official - Middle Name:OYEYEMI
Authorized Official - Last Name:KEKERE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:475-441-3924
Mailing Address - Street 1:511 6TH AVE # 7259
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8436
Mailing Address - Country:US
Mailing Address - Phone:475-441-3924
Mailing Address - Fax:
Practice Address - Street 1:511 6TH AVE # 7259
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8436
Practice Address - Country:US
Practice Address - Phone:475-441-3924
Practice Address - Fax:516-386-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty