Healthcare Provider Details

I. General information

NPI: 1841102316
Provider Name (Legal Business Name): VITAL MIND MENTAL HEALTH COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 S WELLWOOD AVE SUITE A
LINDENHURST NY
11757
US

IV. Provider business mailing address

81101 CIRCLE DR
CENTRAL ISLIP NY
11722-5206
US

V. Phone/Fax

Practice location:
  • Phone: 631-944-5246
  • Fax: 631-651-3696
Mailing address:
  • Phone: 631-944-5246
  • Fax: 631-651-3696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARTYNA WEGRZYNOWSKA
Title or Position: PRESIDENT
Credential:
Phone: 631-944-5246