Provider Demographics
NPI:1922998855
Name:MINDFUL SELF THERAPY LCSW, PLLC
Entity type:Organization
Organization Name:MINDFUL SELF THERAPY LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SISTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:315-761-8388
Mailing Address - Street 1:1868 BLEECKER ST APT 1L
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1347
Mailing Address - Country:US
Mailing Address - Phone:315-761-8388
Mailing Address - Fax:
Practice Address - Street 1:1868 BLEECKER ST APT 1L
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11385-1347
Practice Address - Country:US
Practice Address - Phone:315-761-8388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty