Healthcare Provider Details

I. General information

NPI: 1427807700
Provider Name (Legal Business Name): KAIZEN MINDSET LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 HAZARD AVE STE C6
ENFIELD CT
06082-4587
US

IV. Provider business mailing address

2389 MAIN ST
GLASTONBURY CT
06033-4617
US

V. Phone/Fax

Practice location:
  • Phone: 860-467-1907
  • Fax: 860-718-9509
Mailing address:
  • Phone: 860-467-1907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHERIEFFA JACKSON
Title or Position: OWNER
Credential: APRN
Phone: 860-790-9428