Healthcare Provider Details

I. General information

NPI: 1336788439
Provider Name (Legal Business Name): ADAPTIVE MIND PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S ROSEMARY AVE STE 204
WEST PALM BEACH FL
33401-6310
US

IV. Provider business mailing address

700 S ROSEMARY AVE STE 204
WEST PALM BEACH FL
33401-6310
US

V. Phone/Fax

Practice location:
  • Phone: 561-246-5063
  • Fax:
Mailing address:
  • Phone: 561-246-5063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CARLY LUPO
Title or Position: CEO
Credential: LCSW, BCN
Phone: 561-246-5063