Provider Demographics
NPI:1346969540
Name:MIND GARDEN MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:MIND GARDEN MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MBURU- GERENA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:413-242-6010
Mailing Address - Street 1:220 FORTUNE BLVD # 1009
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1743
Mailing Address - Country:US
Mailing Address - Phone:413-242-6010
Mailing Address - Fax:
Practice Address - Street 1:82 WENDELL AVE # 100
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-7066
Practice Address - Country:US
Practice Address - Phone:413-242-6010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty