Provider Demographics
NPI:1275309817
Name:MIND & BODHI PC
Entity Type:Organization
Organization Name:MIND & BODHI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICSW, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERE
Authorized Official - Middle Name:N
Authorized Official - Last Name:CABRAL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-558-2656
Mailing Address - Street 1:132 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-5002
Mailing Address - Country:US
Mailing Address - Phone:508-558-2656
Mailing Address - Fax:
Practice Address - Street 1:70 CASE AVE # 1
Practice Address - Street 2:
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771-4156
Practice Address - Country:US
Practice Address - Phone:774-901-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health