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General NPI Number Information
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NPI Number | 1578999546
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Entity Type | Organization
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Legal Business Name | MINDFUL THERAPY SOLUTIONS LCSW PLLC
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Dates
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Enumeration Date | 09/22/2013
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 12 JEFFERSON BLVD STE 2
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City | STATEN ISLAND
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State | NY
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Zip | 10312-3330
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Country | US
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Telephone | 718-966-0317
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Fax | 917-791-8248
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Provider Business Mailing Address
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Address Line | 12 JEFFERSON BLVD STE 2
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City | STATEN ISLAND
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State | NY
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Zip | 10312-3330
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Country | US
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Telephone | 718-966-0317
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Fax | 917-791-8248
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Authorized Official
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Title or Position | OWNER/LCSW
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Name | ELISSA DONNER
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Credential |
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Telephone | 718-966-0317
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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 | 079574
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License Number State | NY
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