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General NPI Number Information
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NPI Number | 1134717812
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Entity Type | Organization
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Legal Business Name | MINDS IN MOTION LLC
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Dates
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Enumeration Date | 01/07/2021
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 459 MAIN ST
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City | WEST HAVEN
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State | CT
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Zip | 06516-4219
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Country | US
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Telephone | 914-882-9647
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Fax |
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Provider Business Mailing Address
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Address Line | 589 CAMPBELL AVE., #63
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City | WEST HAVEN
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State | CT
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Zip | 06516
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Country | US
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Telephone | 914-882-9647
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. TATIANA CHANG
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Credential | LCSW
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Telephone | 914-882-9647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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