MEDICARE: HEALTHY MINDS PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649888256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY MINDS PLLC

Provider Business Mailing Address
First Line	:	1161 PALISADO AVE
Second Line	:
City	:	WINDSOR
State	:	CT
Zip	:	06095-1435
Country	:	US
Telephone Number	:	860-214-5688
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 RUSS ST
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06106-1520
Country	:	US
Telephone Number	:	860-544-5926
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER MH
Name	:	MS. MARY ANN RODRIGUEZ
Credential	:	PMHNP - BC
Telephone Number	:	860-214-5688

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	07/20/2020

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Directions to “HEALTHY MINDS PLLC ” Practice Location

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