Healthcare Provider Details

I. General information

NPI: 1982225595
Provider Name (Legal Business Name): POSITIVE MINDSET GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OLD CANOE CREEK RD
SAINT CLOUD FL
34769-1400
US

IV. Provider business mailing address

4735 OLD CANOE CREEK RD
SAINT CLOUD FL
34769-1400
US

V. Phone/Fax

Practice location:
  • Phone: 321-257-3960
  • Fax: 407-604-7677
Mailing address:
  • Phone: 321-257-3960
  • Fax: 407-604-7677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TANIA I MARRERO-SANTIAGO
Title or Position: CEO
Credential: PSYD
Phone: 321-257-3960