Healthcare Provider Details

I. General information

NPI: 1801785092
Provider Name (Legal Business Name): KAREN MINDS AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 GEORGE ST APT 1B
NEW HAVEN CT
06511-5361
US

IV. Provider business mailing address

630 GEORGE ST APT 1B
NEW HAVEN CT
06511-5361
US

V. Phone/Fax

Practice location:
  • Phone: 203-350-9530
  • Fax: 802-541-3801
Mailing address:
  • Phone: 203-350-9530
  • Fax: 802-541-3801

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: KAREN ENNIS
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 203-350-9530