Open-Minded Therapy, LCSW, PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

OPEN-MINDED THERAPY, LCSW, PLLC

Practice address

70 E Sunrise Hwy Ste 500
Valley Stream, NY 11581-1233

Phone

(516) 884-9977

Fax

(516) 862-2702

NPI assigned

Sep 21, 2021

Organization subpart

No

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

Authorized official

Name

Ms. Shantia Nicole Geralds, LCSW, CASAC- MASTERNPI 1093075087

Title

Owner

Phone

(516) 884-9977

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, NJ2 enrollments

Enrollment records 2

Locations

Practitioners 1

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

• Shantia Nicole Geralds, LCSW

  • Clinical Social Worker
  • Valley Stream, NY
  • NPI 1093075087

  NJ

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1632182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632182400000",
    "number": "1730850728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 E SUNRISE HWY STE 500",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115811233",
            "telephone_number": "516-884-9977",
            "fax_number": "516-862-2702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 E SUNRISE HWY STE 500",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115811233",
            "telephone_number": "516-884-9977",
            "fax_number": "516-862-2702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN-MINDED THERAPY, LCSW, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-21",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A",
        "authorized_official_last_name": "GERALDS",
        "authorized_official_first_name": "SHANTIA",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-884-9977",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW, CASAC- MASTER"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Valley Stream, NY
• Providers in Valley Stream, 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 Sep 21, 2021; 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.