Healthcare Provider Details

I. General information

NPI: 1073225645
Provider Name (Legal Business Name): MINDLY THRIVE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MADISON AVE STE 56434
NEW YORK NY
10016-5101
US

IV. Provider business mailing address

8911 N CAPITAL OF TEXAS HWY STE 4200
AUSTIN TX
78759-7439
US

V. Phone/Fax

Practice location:
  • Phone: 914-920-1133
  • Fax: 737-309-3706
Mailing address:
  • Phone: 914-920-1133
  • 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: KAREN SANTANA
Title or Position: OWNER/CLINICIAN
Credential: LCSW
Phone: 914-920-1133