MEDICARE: HEARTFULLY MINDFUL COUNSELING 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	103TC0700X	Clinical Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7961	OTHER	MA	MA LICENSE

General Provider Information

NPI Number	:	1629780564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTFULLY MINDFUL COUNSELING LLC

Provider Business Mailing Address
First Line	:	805 TURNPIKE ST STE 201
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-6122
Country	:	US
Telephone Number	:	978-252-3441
Fax Number	:	978-252-3450

Provider Business Practice Location Address
First Line	:	805 TURNPIKE ST STE 201
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-6122
Country	:	US
Telephone Number	:	978-252-3441
Fax Number	:	978-252-3450

Authorized Official
Title or Position	:	MANAGER
Name	:	CECILIA FERNANDEZ-HALL
Credential	:	PHD
Telephone Number	:	978-252-3441

Provider Enumeration Date	:	12/22/2022
Last Update Date	:	05/06/2024

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