Provider Demographics
NPI:1861049751
Name:MINDFUL LIVING SOCIAL WORK, LCSW, LLC
Entity type:Organization
Organization Name:MINDFUL LIVING SOCIAL WORK, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DELNISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-266-0218
Mailing Address - Street 1:418 BROADWAY STE 5071
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-2922
Mailing Address - Country:US
Mailing Address - Phone:914-266-0218
Mailing Address - Fax:
Practice Address - Street 1:418 BROADWAY STE 5071
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-2922
Practice Address - Country:US
Practice Address - Phone:914-266-0218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-24
Last Update Date:2024-06-18
Deactivation Date:2020-09-16
Deactivation Code:
Reactivation Date:2021-10-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty