Provider Demographics
NPI:1700395894
Name:POSITIVE MIND AND BODY, LLC
Entity Type:Organization
Organization Name:POSITIVE MIND AND BODY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COFOUNDER, PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-553-7748
Mailing Address - Street 1:110 BALA AVE.
Mailing Address - Street 2:3RD FLOOR SUITE
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004
Mailing Address - Country:US
Mailing Address - Phone:484-406-5047
Mailing Address - Fax:610-664-1726
Practice Address - Street 1:110 BALA AVE.
Practice Address - Street 2:3RD FLOOR SUITE
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004
Practice Address - Country:US
Practice Address - Phone:484-406-5047
Practice Address - Fax:610-664-1726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009417101Y00000X, 101YP2500X
PAPS018049103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty