Provider Demographics
NPI:1730850728
Name:OPEN-MINDED THERAPY, LCSW, PLLC
Entity type:Organization
Organization Name:OPEN-MINDED THERAPY, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANTIA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:GERALDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CASAC- MASTER
Authorized Official - Phone:516-884-9977
Mailing Address - Street 1:70 E SUNRISE HWY STE 500
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1233
Mailing Address - Country:US
Mailing Address - Phone:516-884-9977
Mailing Address - Fax:516-862-2702
Practice Address - Street 1:70 E SUNRISE HWY STE 500
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1233
Practice Address - Country:US
Practice Address - Phone:516-884-9977
Practice Address - Fax:516-862-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty