MEDICARE: HEARTS AND MINDS LICENSED CLINICAL SOCIAL WORKER PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1922983659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTS AND MINDS LICENSED CLINICAL SOCIAL WORKER PC

Provider Business Mailing Address
First Line	:	12553 KILLION ST
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-1533
Country	:	US
Telephone Number	:	424-333-0141
Fax Number	:

Provider Business Practice Location Address
First Line	:	12553 KILLION ST
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-1533
Country	:	US
Telephone Number	:	424-333-0141
Fax Number	:

Authorized Official
Title or Position	:	OWNER, THERAPIST
Name	:	SANDRA NOWOSIOLSKI
Credential	:	LCSW
Telephone Number	:	310-666-6456

Provider Enumeration Date	:	08/11/2025
Last Update Date	:	08/11/2025

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