Provider Demographics
NPI:1366139727
Name:FREE MIND THERAPY NY LCSW PLLC
Entity type:Organization
Organization Name:FREE MIND THERAPY NY LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MACCORKINDALE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-578-4430
Mailing Address - Street 1:20 NORTHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2413
Mailing Address - Country:US
Mailing Address - Phone:516-578-4430
Mailing Address - Fax:
Practice Address - Street 1:20 NORTHFIELD DR
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2413
Practice Address - Country:US
Practice Address - Phone:516-578-4430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty