Provider Demographics
NPI:1407415052
Name:MIND BODY WELL THERAPY PLLC
Entity Type:Organization
Organization Name:MIND BODY WELL THERAPY PLLC
Other - Org Name:LUCREZIA MANGIONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR, LPC, LCPC
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCREZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGIONE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:802-578-3700
Mailing Address - Street 1:160 CHRISTIAN ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1221
Mailing Address - Country:US
Mailing Address - Phone:802-578-3700
Mailing Address - Fax:203-463-4211
Practice Address - Street 1:160 CHRISTIAN ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-1221
Practice Address - Country:US
Practice Address - Phone:802-578-3700
Practice Address - Fax:203-463-4211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty