=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518509389
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINDS TOGETHER LCSW PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2019
-----------------------------------------------------
Last Update Date | 10/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10814 72ND AVE STE 2
-----------------------------------------------------
City | FOREST HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11375-5301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-288-0347
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10814 72ND AVE STE 2
-----------------------------------------------------
City | FOREST HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11375-5301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-288-0347
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JEAN CARLOS OSORIO
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 347-288-0347
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------