| Open-minded Therapy, Lcsw, Pllc | |
|
70 E Sunrise Hwy Ste 500 Valley Stream NY 11581-1233 | |
| (516) 884-9977 | |
| (516) 862-2702 |
| Full Name | Open-minded Therapy, Lcsw, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 70 E Sunrise Hwy Ste 500, Valley Stream, New York |
| Authorized Official Name and Position | Shantia Nicole Geralds (OWNER) |
| Authorized Official Contact | 5168849977 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Open-minded Therapy, Lcsw, Pllc 70 E Sunrise Hwy Ste 500 Valley Stream NY 11581-1233 Ph: (516) 884-9977 | Open-minded Therapy, Lcsw, Pllc 70 E Sunrise Hwy Ste 500 Valley Stream NY 11581-1233 Ph: (516) 884-9977 |
| NPI Number | 1730850728 |
|---|---|
| Provider Enumeration Date | 09/21/2021 |
| Last Update Date | 09/21/2021 |
| Certification Date | 09/21/2021 |
| Medicare PECOS PAC ID | 3678971603 |
|---|---|
| Medicare Enrollment ID | O20211006000485 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730850728 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Shantia Nicole Geralds |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093075087 PECOS PAC ID: 4587062518 Enrollment ID: I20211006000557 |
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