Provider Demographics
NPI:1760854442
Name:SONDERMIND PROVIDER NETWORK LLC
Entity Type:Organization
Organization Name:SONDERMIND PROVIDER NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-843-7279
Mailing Address - Street 1:1099 18TH ST STE 2350
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1936
Mailing Address - Country:US
Mailing Address - Phone:844-843-7279
Mailing Address - Fax:720-293-2855
Practice Address - Street 1:720 S COLORADO BLVD PH NORTH
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1904
Practice Address - Country:US
Practice Address - Phone:844-843-7279
Practice Address - Fax:844-416-0584
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SONDERMIND INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-21
Last Update Date:2024-03-19
Deactivation Date:2023-04-02
Deactivation Code:
Reactivation Date:2023-04-04
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty