Healthcare Provider Details

I. General information

NPI: 1376429589
Provider Name (Legal Business Name): MINDS AND MOTION WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 FEDERAL RD BUILDING A, SUITE 201
BROOKFIELD CT
06804-0680
US

IV. Provider business mailing address

67 FEDERAL RD BUILDING A, SUITE 201
BROOKFIELD CT
06804
US

V. Phone/Fax

Practice location:
  • Phone: 860-317-6005
  • Fax:
Mailing address:
  • Phone: 860-317-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE DIPISA
Title or Position: OWNER
Credential: LPC
Phone: 860-317-6005