Provider Demographics
NPI:1225474554
Name:TRANQUILITY OF MIND LCSW PC
Entity Type:Organization
Organization Name:TRANQUILITY OF MIND LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AGNELO
Authorized Official - Middle Name:BENVINDO
Authorized Official - Last Name:DIAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-350-8379
Mailing Address - Street 1:595 DOGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3128
Mailing Address - Country:US
Mailing Address - Phone:516-350-8379
Mailing Address - Fax:631-476-0728
Practice Address - Street 1:28 NORTH COUNTRY RD.
Practice Address - Street 2:SUITE 101
Practice Address - City:MT. SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766
Practice Address - Country:US
Practice Address - Phone:516-350-8379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty