Healthcare Provider Details

I. General information

NPI: 1740501071
Provider Name (Legal Business Name): MINDFUL SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 BENMONT AVE SUITE 20
BENNINGTON VT
05201-1873
US

IV. Provider business mailing address

157 COBBLE HL
SHAFTSBURY VT
05262-9241
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-3520
  • Fax:
Mailing address:
  • Phone: 802-442-3520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0480000729
License Number StateVT

VIII. Authorized Official

Name: LISA PEZZULICH
Title or Position: OWNER
Credential:
Phone: 802-442-3520