Healthcare Provider Details

I. General information

NPI: 1477461648
Provider Name (Legal Business Name): MIND & BODY NEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11303 AMHERST AVE STE 3
SILVER SPRING MD
20902-4600
US

IV. Provider business mailing address

11303 AMHERST AVE STE 3
SILVER SPRING MD
20902-4600
US

V. Phone/Fax

Practice location:
  • Phone: 301-844-6129
  • Fax:
Mailing address:
  • Phone: 301-844-6129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: WENDY GUBERMAN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 845-300-1092