Healthcare Provider Details

I. General information

NPI: 1013842426
Provider Name (Legal Business Name): MOSAIC MIND: PSYCHOTHERAPY & CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5541 SW 11TH ST APT B
MARGATE FL
33068-2971
US

IV. Provider business mailing address

5541 SW 11TH ST APT B
MARGATE FL
33068-2971
US

V. Phone/Fax

Practice location:
  • Phone: 754-300-6039
  • Fax:
Mailing address:
  • Phone: 754-300-6039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. TIMITRA SHANELL MARTIN
Title or Position: OWNER / MANAGING MEMBER
Credential: LCSW, MSW
Phone: 561-816-9027