Provider Demographics
NPI:1467211425
Name:MINDFUL SUPPORT AND MENTAL HEALTH SOLUTIONS LLC
Entity Type:Organization
Organization Name:MINDFUL SUPPORT AND MENTAL HEALTH SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERONE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-206-5375
Mailing Address - Street 1:708 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4149
Mailing Address - Country:US
Mailing Address - Phone:321-206-5375
Mailing Address - Fax:321-251-6622
Practice Address - Street 1:708 CARRIAGE LN
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4149
Practice Address - Country:US
Practice Address - Phone:321-206-5375
Practice Address - Fax:321-251-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty