Healthcare Provider Details

I. General information

NPI: 1457506735
Provider Name (Legal Business Name): ROCIO DE BELEN MIMBELA MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2008
Last Update Date: 01/21/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 CARRIAGE CROSSING LN
MIDDLETOWN CT
06457-5863
US

IV. Provider business mailing address

233 CARRIAGE CROSSING LN
MIDDLETOWN CT
06457-5863
US

V. Phone/Fax

Practice location:
  • Phone: 973-800-6868
  • Fax:
Mailing address:
  • Phone: 973-800-6868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number106378
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number006618
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1202
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: