MEDICARE: MINDFUL INTEGRATIVE HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1306631114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL INTEGRATIVE HEALTH LLC

Provider Business Mailing Address
First Line	:	71 LEGION PKWY STE 26
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-7225
Country	:	US
Telephone Number	:	774-826-6348
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 LEGION PKWY STE 26
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-7225
Country	:	US
Telephone Number	:	774-826-6348
Fax Number	:

Authorized Official
Title or Position	:	OWNER / AUTHORIZED OFFICIAL
Name	:	ANA DEPINA
Credential	:	PMHNP
Telephone Number	:	774-826-6348

Provider Enumeration Date	:	04/11/2025
Last Update Date	:	04/11/2025

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