Provider Demographics
NPI:1487549010
Name:MOSAIC MIND PSYCHOTHERAPY LCSW PC
Entity type:Organization
Organization Name:MOSAIC MIND PSYCHOTHERAPY LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-532-9268
Mailing Address - Street 1:21 MAPLE AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8752
Mailing Address - Country:US
Mailing Address - Phone:631-532-9268
Mailing Address - Fax:
Practice Address - Street 1:21 MAPLE AVE STE 106
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8752
Practice Address - Country:US
Practice Address - Phone:631-532-9268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty