Healthcare Provider Details

I. General information

NPI: 1487519807
Provider Name (Legal Business Name): MIND AND BODY BALANCED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 WATERBURY RD STE 322
PROSPECT CT
06712-1256
US

IV. Provider business mailing address

47 WATERBURY RD STE 322
PROSPECT CT
06712-1256
US

V. Phone/Fax

Practice location:
  • Phone: 914-252-3976
  • Fax: 914-416-5658
Mailing address:
  • Phone: 914-252-3976
  • Fax: 914-416-5658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA LUCY WILLIAMS
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 914-252-3976