Provider Demographics
NPI:1760113245
Name:RENEWED MIND THERAPY
Entity Type:Organization
Organization Name:RENEWED MIND THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COFOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-535-7350
Mailing Address - Street 1:565 CLARK AVE APT 75
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4055
Mailing Address - Country:US
Mailing Address - Phone:203-535-7350
Mailing Address - Fax:
Practice Address - Street 1:38 KELLEY ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5715
Practice Address - Country:US
Practice Address - Phone:203-535-7350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008107263Medicaid