Provider Demographics
NPI:1174204762
Name:THE SOCIAL MIND MENTAL HEALTH COUNSELING P.C.
Entity type:Organization
Organization Name:THE SOCIAL MIND MENTAL HEALTH COUNSELING P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:JOSEFA
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:631-902-4981
Mailing Address - Street 1:20 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11724-1820
Mailing Address - Country:US
Mailing Address - Phone:631-683-8485
Mailing Address - Fax:
Practice Address - Street 1:153 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLD SPRING HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11724-1437
Practice Address - Country:US
Practice Address - Phone:631-902-4981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health