Healthcare Provider Details

I. General information

NPI: 1477795383
Provider Name (Legal Business Name): CLEAR MINDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34444 KING STREET ROW SUITE 4B
LEWES DE
19958-1514
US

IV. Provider business mailing address

PO BOX 30
LINCOLN DE
19960-0030
US

V. Phone/Fax

Practice location:
  • Phone: 302-644-2773
  • Fax:
Mailing address:
  • Phone: 302-644-2773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLI-0000107
License Number StateDE

VIII. Authorized Official

Name: KIMBERLY GERARDI
Title or Position: OWNER
Credential: APN
Phone: 302-644-2773