Provider Demographics
NPI:1497338396
Name:MINDFUL MENTAL HEALTH CT SOUTH LLC
Entity Type:Organization
Organization Name:MINDFUL MENTAL HEALTH CT SOUTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-720-8509
Mailing Address - Street 1:31 KACHELE ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612-2063
Mailing Address - Country:US
Mailing Address - Phone:203-551-7301
Mailing Address - Fax:
Practice Address - Street 1:31 KACHELE ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:CT
Practice Address - Zip Code:06612-2063
Practice Address - Country:US
Practice Address - Phone:203-551-7301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty