Provider Demographics
NPI:1457825606
Name:MENDING MINDS, HEALING HEARTS, LLC
Entity Type:Organization
Organization Name:MENDING MINDS, HEALING HEARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MATTLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-703-7849
Mailing Address - Street 1:536 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1213
Mailing Address - Country:US
Mailing Address - Phone:609-703-7849
Mailing Address - Fax:609-904-5543
Practice Address - Street 1:536 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1213
Practice Address - Country:US
Practice Address - Phone:609-703-7849
Practice Address - Fax:609-904-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty