Provider Demographics
NPI:1083891139
Name:CENTER FOR MINDFUL CHANGE, LLC
Entity Type:Organization
Organization Name:CENTER FOR MINDFUL CHANGE, LLC
Other - Org Name:KATHRYN A GRIFFITHS MSW,LCSW,BCD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRIFFITHS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LCSW,BCD
Authorized Official - Phone:973-257-5666
Mailing Address - Street 1:550 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1168
Mailing Address - Country:US
Mailing Address - Phone:973-257-5666
Mailing Address - Fax:
Practice Address - Street 1:550 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1168
Practice Address - Country:US
Practice Address - Phone:973-257-5666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC04309700261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ002749Medicare Oscar/Certification