Provider Demographics
NPI:1629852918
Name:MENDFUL MINDS WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:MENDFUL MINDS WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:COURDUFF
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:267-474-9003
Mailing Address - Street 1:2 SCENIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-3012
Mailing Address - Country:US
Mailing Address - Phone:856-526-9652
Mailing Address - Fax:
Practice Address - Street 1:2737 N 5TH ST FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-2702
Practice Address - Country:US
Practice Address - Phone:267-831-2157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty