Provider Demographics
NPI:1063278471
Name:MINDFUL INTENTIONS LCSW PSYCHOTHERAPY PLLC
Entity type:Organization
Organization Name:MINDFUL INTENTIONS LCSW PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:267-225-8763
Mailing Address - Street 1:2 SHELBY CT
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4930
Mailing Address - Country:US
Mailing Address - Phone:631-871-3675
Mailing Address - Fax:
Practice Address - Street 1:1547 WALT WHITMAN RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3015
Practice Address - Country:US
Practice Address - Phone:267-225-8763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty