Healthcare Provider Details

I. General information

NPI: 1497454334
Provider Name (Legal Business Name): POSITIVE MINDS THERAPY LCSW P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E MAIN ST STE 5&8
PATCHOGUE NY
11772-3196
US

IV. Provider business mailing address

795 TERRY RD
HAUPPAUGE NY
11788-3426
US

V. Phone/Fax

Practice location:
  • Phone: 631-562-5992
  • Fax:
Mailing address:
  • Phone: 631-562-5992
  • 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: JUSTIN BENSON
Title or Position: PRESIDENT
Credential: LCSW-R
Phone: 631-487-2844