Provider Demographics
NPI:1770724379
Name:A MINDFUL PATH, LLC
Entity type:Organization
Organization Name:A MINDFUL PATH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SERVICE OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:TURGEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-292-3126
Mailing Address - Street 1:1477 PARK STREET
Mailing Address - Street 2:SUITE 14
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106
Mailing Address - Country:US
Mailing Address - Phone:860-402-9333
Mailing Address - Fax:
Practice Address - Street 1:1477 PARK STREET
Practice Address - Street 2:SUITE 14
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-402-9333
Practice Address - Fax:860-499-5477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0037291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003729OtherLICENSE NUMVER