Provider Demographics
NPI:1376273813
Name:MINDFUL BALANCE, LLC
Entity Type:Organization
Organization Name:MINDFUL BALANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-224-8867
Mailing Address - Street 1:263 LAFAYETTE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4725
Mailing Address - Country:US
Mailing Address - Phone:781-248-1810
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR STE 225C
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6153
Practice Address - Country:US
Practice Address - Phone:978-224-8867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health