Provider Demographics
NPI:1811509730
Name:THEMINDFULLCUP, LLC
Entity type:Organization
Organization Name:THEMINDFULLCUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER & PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMAYO
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LPC, LMHC
Authorized Official - Phone:860-264-5565
Mailing Address - Street 1:1204 MAIN ST # 772
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3787
Mailing Address - Country:US
Mailing Address - Phone:860-264-5565
Mailing Address - Fax:
Practice Address - Street 1:2 CORPORATE DR STE 950
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6246
Practice Address - Country:US
Practice Address - Phone:860-264-5565
Practice Address - Fax:888-220-8727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-21
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty