Healthcare Provider Details

I. General information

NPI: 1720916075
Provider Name (Legal Business Name): MINDFUL PATH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

139 CHAD BROWN ST APT 2
PROVIDENCE RI
02908-3656
US

IV. Provider business mailing address

139 CHAD BROWN ST APT 2
PROVIDENCE RI
02908-3656
US

V. Phone/Fax

Practice location:
  • Phone: 908-328-6826
  • Fax:
Mailing address:
  • Phone: 908-328-6826
  • 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

VIII. Authorized Official

Name: MEGHAN NORSIGIAN
Title or Position: LLC MEMBER/ CLINICIAN
Credential: LICSW
Phone: 908-328-6826