Healthcare Provider Details

I. General information

NPI: 1720798317
Provider Name (Legal Business Name): BE MINDFUL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 ALBANY AVE STE 203B
WEST HARTFORD CT
06117-2523
US

IV. Provider business mailing address

PO BOX 4172
WINDSOR LOCKS CT
06096-4172
US

V. Phone/Fax

Practice location:
  • Phone: 203-668-1718
  • Fax: 860-891-6263
Mailing address:
  • Phone: 203-668-1718
  • Fax: 860-891-6263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TANESHA S PICKARD
Title or Position: CLINICAL DIRECTOR
Credential: LCSW, LICSW
Phone: 203-668-1718