| Entity Name: | ADAPTIVE MIND PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 09 May 2019 (6 years ago) |
| Document Number: | L19000125876 |
| FEI/EIN Number | 84-2691476 |
| Address: | 1016 Clare Ave, Suite 5, West Palm Beach, FL 33401 |
| Mail Address: | 1016 Clare Ave, Suite 5, West Palm Beach, FL 33401 |
| ZIP code: | 33401 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336788439 | 2020-01-06 | 2020-08-11 | 700 S ROSEMARY AVE STE 204, WEST PALM BEACH, FL, 334016310, US | 700 S ROSEMARY AVE STE 204, WEST PALM BEACH, FL, 334016310, US | |||||||||||||||||||||||
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| Phone | +1 561-246-5063 |
Authorized person
| Name | CARLY LUPO |
| Role | CEO |
| Phone | 5612465063 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | Yes |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 103557300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LUPO, CARLY N | Agent | 591 Evernia St, Apt 2312, West Palm Beach, FL 33401 |
| Name | Role | Address |
|---|---|---|
| LUPO, CARLY N | Chief Executive Officer | 591 Evernia St, Apt 2312 West Palm Beach, FL 33401 |
| Name | Role | Address |
|---|---|---|
| Bailey, Thomas | Biller | 1016 Clare Ave, Suite 5 West Palm Beach, FL 33401 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-02 | 591 Evernia St, Apt 2312, West Palm Beach, FL 33401 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-13 | 1016 Clare Ave, Suite 5, West Palm Beach, FL 33401 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-13 | 1016 Clare Ave, Suite 5, West Palm Beach, FL 33401 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-02 |
| ANNUAL REPORT | 2023-04-13 |
| ANNUAL REPORT | 2022-04-28 |
| ANNUAL REPORT | 2021-08-26 |
| ANNUAL REPORT | 2020-06-29 |
| Florida Limited Liability | 2019-05-09 |
Date of last update: 16 Feb 2025
Sources: Florida Department of State
