Provider Demographics
NPI:1821841206
Name:MINDFULNESS RENEWED LLC
Entity Type:Organization
Organization Name:MINDFULNESS RENEWED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-580-9883
Mailing Address - Street 1:107 FENN RD STE G
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2250
Mailing Address - Country:US
Mailing Address - Phone:860-580-9883
Mailing Address - Fax:
Practice Address - Street 1:107 FENN RD STE G
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2250
Practice Address - Country:US
Practice Address - Phone:860-580-9883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health