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General NPI Number Information
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NPI Number | 1225474554
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Entity Type | Organization
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Legal Business Name | TRANQUILITY OF MIND LCSW PC
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 28 NORTH COUNTRY RD. SUITE 101
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City | MT. SINAI
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State | NY
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Zip | 11766
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Country | US
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Telephone | 516-350-8379
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Fax |
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Provider Business Mailing Address
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Address Line | 595 DOGWOOD AVE
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City | WEST HEMPSTEAD
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State | NY
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Zip | 11552-3128
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Country | US
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Telephone | 516-350-8379
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Fax | 631-476-0728
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Authorized Official
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Title or Position | CEO
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Name | DR. AGNELO BENVINDO DIAS
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Credential | LCSW
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Telephone | 516-350-8379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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