Provider Demographics
NPI:1164887683
Name:SERENE MINDS, LLC
Entity Type:Organization
Organization Name:SERENE MINDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-478-6199
Mailing Address - Street 1:8 PENNOCK DR
Mailing Address - Street 2:
Mailing Address - City:GARNET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19060-1400
Mailing Address - Country:US
Mailing Address - Phone:302-312-9478
Mailing Address - Fax:302-397-2395
Practice Address - Street 1:410 FOULK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3820
Practice Address - Country:US
Practice Address - Phone:302-478-6199
Practice Address - Fax:302-397-2395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC-1 0007149261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)