Provider Demographics
NPI:1265820492
Name:MINDFUL ALTERATION
Entity Type:Organization
Organization Name:MINDFUL ALTERATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:TANNER
Authorized Official - Last Name:OLGIATI
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-998-1523
Mailing Address - Street 1:15 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3529
Mailing Address - Country:US
Mailing Address - Phone:603-998-1523
Mailing Address - Fax:
Practice Address - Street 1:15 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3529
Practice Address - Country:US
Practice Address - Phone:603-998-1523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH17711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty