Healthcare Provider Details

I. General information

NPI: 1255293833
Provider Name (Legal Business Name): MENDED MIND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 ROLLING RD
SALISBURY MD
21801-7115
US

IV. Provider business mailing address

415 ROLLING RD
SALISBURY MD
21801-7115
US

V. Phone/Fax

Practice location:
  • Phone: 410-422-1843
  • Fax:
Mailing address:
  • Phone: 410-422-1843
  • Fax:

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: FARAH VANGENDEREN
Title or Position: OWNER
Credential: LCSWC
Phone: 410-422-1843