NPIMap

Organization Active NPI

Mindful Therapy LCSW, PLLC

  • Clinical Social Worker
  • Commack, NY
National Provider Identifier
1275014136
Registry record updated Aug 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
R058833-1 Issued in NY
Legal business name
MINDFUL THERAPY LCSW, PLLC
Practice address
2171 Jericho Turnpike
Suite 335
Commack, NY 11725
Phone
(631) 486-7788
NPI assigned
Aug 28, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Janis Hoffman, LCSWRNPI 1184983835
Title
Owner
Phone
(917) 596-1040

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X R058833-1 NY Primary

Addresses

Primary practice location

2171 Jericho Turnpike
Suite 335
Commack, NY 11725

Mailing address

5 Priory CT
Melville, NY 11747-3914
Phone (917) 596-1040

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190205003008 NY Part B Supplier - Clinic/Group Practice 8527306281 Receives reassigned benefits from 13 practitioners
Practice locations: Commack, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535414400000",
    "number": "1275014136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 PRIORY CT",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117473914",
            "telephone_number": "917-596-1040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2171 JERICHO TURNPIKE",
            "address_2": "SUITE 335",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "11725",
            "telephone_number": "631-486-7788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL THERAPY LCSW, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-28",
        "last_updated": "2018-08-28",
        "status": "A",
        "authorized_official_last_name": "HOFFMAN",
        "authorized_official_first_name": "JANIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-596-1040",
        "authorized_official_credential": "LCSWR"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R058833-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Commack, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.