Provider Demographics
NPI:1871136564
Name:RESILIENT MIND LICENSED CLINICAL SOCIAL WORK SERVICES, PC
Entity type:Organization
Organization Name:RESILIENT MIND LICENSED CLINICAL SOCIAL WORK SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-328-8175
Mailing Address - Street 1:541 BAY RIDGE PKWY STE L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3309
Mailing Address - Country:US
Mailing Address - Phone:929-200-3049
Mailing Address - Fax:
Practice Address - Street 1:541 BAY RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3309
Practice Address - Country:US
Practice Address - Phone:929-200-3049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty