MEDICARE: MINDFUL THERAPY SOLUTIONS LCSW PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	079574	NY

General Provider Information

NPI Number	:	1578999546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL THERAPY SOLUTIONS LCSW PLLC

Provider Business Mailing Address
First Line	:	12 JEFFERSON BLVD STE 2
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3330
Country	:	US
Telephone Number	:	718-966-0317
Fax Number	:	917-791-8248

Provider Business Practice Location Address
First Line	:	12 JEFFERSON BLVD STE 2
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3330
Country	:	US
Telephone Number	:	718-966-0317
Fax Number	:	917-791-8248

Authorized Official
Title or Position	:	OWNER/LCSW
Name	:	ELISSA DONNER
Credential	:
Telephone Number	:	718-966-0317

Provider Enumeration Date	:	09/22/2013
Last Update Date	:	12/01/2025

Similar Medicare Providers

1902755879 — ZAINAB KHAN
Practice Location Address:

12 JEFFERSON BLVD STE 2
STATEN ISLAND, NY
10312-3330

Practice Phone: 718-500-1726
Practice Fax:

1093070872 — ELISSA DONNER-GUZMAN LCSW-R
Practice Location Address:

12 JEFFERSON BLVD STE 2
STATEN ISLAND, NY
10312-3330

Practice Phone: 718-966-0317
Practice Fax: 917-791-8248

1689298044 — MICHELLE RENEE PERLONGO LMHC
Practice Location Address:

12 JEFFERSON BLVD STE 2
STATEN ISLAND, NY
10312-3330

Practice Phone: 718-966-0317
Practice Fax: 917-791-8248

1831713296 — BRITTANY ROSE DIFALCO LMHC
Practice Location Address:

12 JEFFERSON BLVD STE 2
STATEN ISLAND, NY
10312-3330

Practice Phone: 718-966-0317
Practice Fax: 917-791-8248

1336492917 — MR. GILBERTO SUERO LCSW
Practice Location Address:

486 BUEL AVE
STATEN ISLAND, NY
10305-3330

Practice Phone: 718-600-0316
Practice Fax:

1548859192 — WALK ON WATER MINISTRIES OF CENTRAL FLORIDA (WOW) INC.
Practice Location Address:

3330 PERKINSON LN MERRITT ISLAND FL 32953
MERRITT ISLAND, FL
32953-3295

Practice Phone: 321-412-8057
Practice Fax:

Directions to “MINDFUL THERAPY SOLUTIONS LCSW PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.