Healthcare Provider Details

I. General information

NPI: 1720995665
Provider Name (Legal Business Name): GROUNDED MIND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 SOUTHAVEN AVE
MASTIC NY
11950-3929
US

IV. Provider business mailing address

108 SOUTHAVEN AVE
MASTIC NY
11950-3929
US

V. Phone/Fax

Practice location:
  • Phone: 631-918-9097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE RATUSZNY
Title or Position: SOCIAL WORKER
Credential: LCSW
Phone: 631-918-9097