Provider Demographics
NPI:1770940629
Name:MINDFUL HEALING LLC
Entity type:Organization
Organization Name:MINDFUL HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TSANGARIDES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-387-5689
Mailing Address - Street 1:43 SHERMAN HILL RD
Mailing Address - Street 2:BLG D, SUITE 104
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-3651
Mailing Address - Country:US
Mailing Address - Phone:860-387-5689
Mailing Address - Fax:
Practice Address - Street 1:9 RIDGE CT
Practice Address - Street 2:
Practice Address - City:OAKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06779-2406
Practice Address - Country:US
Practice Address - Phone:860-387-5689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-23
Last Update Date:2016-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT71221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty