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General NPI Number Information
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NPI Number | 1285266882
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Entity Type | Organization
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Legal Business Name | BALANCED MIND COUNSELING AND WELLNESS
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Dates
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Enumeration Date | 02/11/2020
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Last Update Date | 05/27/2020
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Provider Practice Location Address
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Address Line | 2 OAK STREET SUITE 201
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City | MASHPEE
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State | MA
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Zip | 02649
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Country | US
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Telephone | 401-378-0966
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Fax |
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Provider Business Mailing Address
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Address Line | 218 LITTLE RIVER RD
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City | COTUIT
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State | MA
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Zip | 02635-2805
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Country | US
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Telephone | 401-378-0966
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACQUELINE PROVENZANO
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Credential | LICSW
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Telephone | 401-378-0966
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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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