Nourish Your Mind, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

085591 Issued in NY

Legal business name

NOURISH YOUR MIND, LLC

Practice address

360 State Route 17M Ste 4
Monroe, NY 10950-3444

Phone

(845) 547-0479

Fax

(845) 547-0479

NPI assigned

May 23, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jessica C Sullivan, LCSWNPI 1396085304

Title

Owner

Phone

(845) 547-0479

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jessica C Sullivan, LCSW-R

  • Clinical Social Worker
  • Monroe, NY
  • NPI 1396085304
  NPD Authorized official

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

{
    "created_epoch": "1495497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1649707555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 STATE ROUTE 17M STE 4",
            "city": "MONROE",
            "state": "NY",
            "postal_code": "109503444",
            "telephone_number": "845-547-0479",
            "fax_number": "845-547-0479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 STATE ROUTE 17M STE 4",
            "city": "MONROE",
            "state": "NY",
            "postal_code": "109503444",
            "telephone_number": "845-547-0479",
            "fax_number": "845-547-0479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOURISH YOUR MIND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-23",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "845-547-0479",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "085591",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Nicoll, MD
• Themistoklis J Nissirios, MD
• Angela Marie Nonnon, MSED
• Joan Norris
• Northeast Orthopedics and Sports Medicine PLLC
• Kellyann Marie O'Connor
• Dawn Elizabeth O'Dell, LCSW
• Elizabeth Maria O'Shea, M.C.
• Elizabeth R Oelofse, COTA/L
• Jeanette Leonie Officer

• Clinical Social Worker in Monroe, NY
• Providers in Monroe, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.