Provider Demographics
NPI:1497261481
Name:MINDFULNESS AND CHANGE GROUP, LLC
Entity Type:Organization
Organization Name:MINDFULNESS AND CHANGE GROUP, LLC
Other - Org Name:THE MINDFULNESS & CHANGE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLODYNA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:617-690-9645
Mailing Address - Street 1:40 SPRING ST STE 215
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3474
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:844-238-9457
Practice Address - Street 1:40 SPRING ST STE 215
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3474
Practice Address - Country:US
Practice Address - Phone:617-690-9645
Practice Address - Fax:844-238-9457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-28
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty