Provider Demographics
NPI:1982225595
Name:POSITIVE MINDSET GROUP
Entity Type:Organization
Organization Name:POSITIVE MINDSET GROUP
Other - Org Name:POSITIVE MINDSET GROUP LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:MARRERO-SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-257-3960
Mailing Address - Street 1:4735 OLD CANOE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-1400
Mailing Address - Country:US
Mailing Address - Phone:321-257-3960
Mailing Address - Fax:407-604-7677
Practice Address - Street 1:4735 OLD CANOE CREEK RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-1400
Practice Address - Country:US
Practice Address - Phone:321-257-3960
Practice Address - Fax:407-604-7677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102316900Medicaid
FL14356948OtherCAQH