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General NPI Number Information
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NPI Number | 1528959657
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Entity Type | Organization
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Legal Business Name | DIVINE MIND THERAPY
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Dates
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Enumeration Date | 07/15/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 516 VAUXHALL ST STE 101
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City | NEW LONDON
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State | CT
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Zip | 06320-2609
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Country | US
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Telephone | 860-333-0243
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Fax |
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Provider Business Mailing Address
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Address Line | 12 GIOVANNI DR
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City | WATERFORD
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State | CT
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Zip | 06385-1725
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Country | US
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Telephone | 860-235-8047
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Fax |
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | GERALYN JONES
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Credential | LCSW
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Telephone | 860-333-0243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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