Provider Demographics
NPI:1336788439
Name:ADAPTIVE MIND PLLC
Entity Type:Organization
Organization Name:ADAPTIVE MIND PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUPO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, BCN
Authorized Official - Phone:561-246-5063
Mailing Address - Street 1:700 S ROSEMARY AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-6310
Mailing Address - Country:US
Mailing Address - Phone:561-246-5063
Mailing Address - Fax:
Practice Address - Street 1:700 S ROSEMARY AVE STE 204
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-6310
Practice Address - Country:US
Practice Address - Phone:561-246-5063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-06
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103557300Medicaid