Healthcare Provider Details

I. General information

NPI: 1265626899
Provider Name (Legal Business Name): MIND MANAGEMENT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CENTRAL AVE
NORWICH CT
06360-4753
US

IV. Provider business mailing address

20 CENTRAL AVE
NORWICH CT
06360-4753
US

V. Phone/Fax

Practice location:
  • Phone: 860-889-4944
  • Fax: 860-889-4944
Mailing address:
  • Phone: 860-889-4944
  • Fax: 860-889-4944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1041C0700X
License Number StateCT

VIII. Authorized Official

Name: MRS. DIANE MARIE PAGE
Title or Position: CLINICAL SOCIAL WORKER / VICE PRESI
Credential: LCSW
Phone: 860-889-4944