Healthcare Provider Details

I. General information

NPI: 1205607090
Provider Name (Legal Business Name): MINDFUL INTERVENTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 POST RD
FAIRFIELD CT
06824-6220
US

IV. Provider business mailing address

29 DELL DALE RD
FAIRFIELD CT
06824-2425
US

V. Phone/Fax

Practice location:
  • Phone: 646-248-9332
  • Fax:
Mailing address:
  • Phone: 164-624-8933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONALD A MCCOY
Title or Position: CEO
Credential: LPC
Phone: 646-248-9332