Healthcare Provider Details

I. General information

NPI: 1972422194
Provider Name (Legal Business Name): ASSOCIATED MIND AND BODY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 GRASSY PLAIN ST
BETHEL CT
06801-2876
US

IV. Provider business mailing address

182 GRASSY PLAIN ST
BETHEL CT
06801-2876
US

V. Phone/Fax

Practice location:
  • Phone: 475-529-5243
  • Fax:
Mailing address:
  • Phone: 475-529-5243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: KATHERINE COFFEY
Title or Position: OWNER
Credential: LCSW
Phone: 203-240-2605