Provider Demographics
NPI:1184403552
Name:MIND & HEART CONNECT LLC
Entity type:Organization
Organization Name:MIND & HEART CONNECT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAITEY
Authorized Official - Middle Name:V
Authorized Official - Last Name:ETIENNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-451-2967
Mailing Address - Street 1:7750 OKEECHOBEE BLVD # 4-1200
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-2104
Mailing Address - Country:US
Mailing Address - Phone:954-451-2967
Mailing Address - Fax:
Practice Address - Street 1:207 SEMINOLE LAKES DR
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-4208
Practice Address - Country:US
Practice Address - Phone:954-451-2967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty