Provider Demographics
NPI:1619581493
Name:WHOLE CONNECTION; MINDFUL REFLECTION, LLC
Entity Type:Organization
Organization Name:WHOLE CONNECTION; MINDFUL REFLECTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:CABADA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:917-733-5499
Mailing Address - Street 1:245 E 93RD ST APT 9J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3965
Mailing Address - Country:US
Mailing Address - Phone:917-733-5499
Mailing Address - Fax:
Practice Address - Street 1:1751 2ND AVE STE AZ-5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5363
Practice Address - Country:US
Practice Address - Phone:917-733-5499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)