Provider Demographics
NPI:1144770264
Name:MENDING HEARTS, LLC
Entity Type:Organization
Organization Name:MENDING HEARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/LICENSED FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-817-0738
Mailing Address - Street 1:46 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4944
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:381 CENTER ST
Practice Address - Street 2:STE A
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3924
Practice Address - Country:US
Practice Address - Phone:860-952-9142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1844106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty