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General NPI Number Information
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NPI Number | 1407415052
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Entity Type | Organization
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Legal Business Name | MIND BODY WELL THERAPY PLLC
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Dates
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Enumeration Date | 06/07/2019
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Last Update Date | 09/17/2021
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Provider Practice Location Address
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Address Line | 160 CHRISTIAN ST
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City | OXFORD
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State | CT
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Zip | 06478-1221
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Country | US
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Telephone | 802-578-3700
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Fax | 203-463-4211
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Provider Business Mailing Address
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Address Line | 160 CHRISTIAN ST
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City | OXFORD
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State | CT
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Zip | 06478-1221
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Country | US
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Telephone | 802-578-3700
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Fax | 203-463-4211
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Authorized Official
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Title or Position | OWNER, CLINICAL DIRECTOR, LPC, LCPC
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Name | MS. LUCREZIA MANGIONE
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Credential | LPC
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Telephone | 802-578-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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