Healthcare Provider Details

I. General information

NPI: 1104739143
Provider Name (Legal Business Name): MARIGOLD MIND & BODY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 MAIN ST
FARMINGTON CT
06032-2985
US

IV. Provider business mailing address

876 PLAINVILLE AVE
FARMINGTON CT
06032-3185
US

V. Phone/Fax

Practice location:
  • Phone: 860-352-5527
  • Fax:
Mailing address:
  • Phone: 860-921-3192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TAYLOR LYNCH
Title or Position: CLINICIAN
Credential: LPC
Phone: 860-921-3192