Healthcare Provider Details

I. General information

NPI: 1053079301
Provider Name (Legal Business Name): MINDFUL BREASTFEEDING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ALBERT AVE
WETHERSFIELD CT
06109-1003
US

IV. Provider business mailing address

75 ALBERT AVE
WETHERSFIELD CT
06109-1003
US

V. Phone/Fax

Practice location:
  • Phone: 860-266-7745
  • Fax:
Mailing address:
  • Phone: 860-266-7745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. BEATA LIDIA HARASIM
Title or Position: FOUNDER, CEO
Credential: PT, DPT, FAAOMPT
Phone: 860-833-4606