Healthcare Provider Details

I. General information

NPI: 1275309817
Provider Name (Legal Business Name): MIND & BODHI PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 CASE AVE # 1
SEEKONK MA
02771-4156
US

IV. Provider business mailing address

132 BAKER RD
SWANSEA MA
02777-5002
US

V. Phone/Fax

Practice location:
  • Phone: 774-901-4800
  • Fax:
Mailing address:
  • Phone: 508-558-2656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JERE N CABRAL
Title or Position: LICSW, OWNER
Credential: LICSW
Phone: 508-558-2656