MEDICARE: HEALTHY MINDS HEALTHY HEARTS, 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1629662390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY MINDS HEALTHY HEARTS, LLC

Provider Business Mailing Address
First Line	:	3748 TWIN LAKES CT
Second Line	:
City	:	WINDSOR MILL
State	:	MD
Zip	:	21244-3703
Country	:	US
Telephone Number	:	919-805-8701
Fax Number	:

Provider Business Practice Location Address
First Line	:	3748 TWIN LAKES CT
Second Line	:
City	:	WINDSOR MILL
State	:	MD
Zip	:	21244-3703
Country	:	US
Telephone Number	:	919-805-8701
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER, LCSW-C
Name	:	TONI E MAYNOR
Credential	:	LCSW-C
Telephone Number	:	919-805-8701

Provider Enumeration Date	:	02/23/2021
Last Update Date	:	02/23/2021

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