Healthcare Provider Details

I. General information

NPI: 1316568660
Provider Name (Legal Business Name): MINDFUL CONNECTIONS PSYCHOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 NEW PARK AVENUE SUITE 117
HARTFORD CT
06106-2170
US

IV. Provider business mailing address

151 NEW PARK AVENUE SUITE 117
HARTFORD CT
06106-2152
US

V. Phone/Fax

Practice location:
  • Phone: 407-913-4396
  • Fax:
Mailing address:
  • Phone: 407-913-4396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ANGELICA VALENTIN-COLON
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSY.D.
Phone: 407-913-4396