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General NPI Number Information
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NPI Number | 1639582661
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Entity Type | Organization
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Legal Business Name | MINDFUL CONNECTIONS, LLC
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Dates
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Enumeration Date | 06/06/2014
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Last Update Date | 06/06/2014
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Provider Practice Location Address
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Address Line | 3042 N FEDERAL HWY SUITE 207
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City | FORT LAUDERDALE
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State | FL
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Zip | 33306-1400
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Country | US
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Telephone | 954-770-2363
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Fax |
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Provider Business Mailing Address
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Address Line | 733 NW 30TH CT UNIT # 7
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City | WILTON MANORS
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State | FL
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Zip | 33311-2400
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Country | US
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Telephone | 954-770-2363
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Fax |
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | BENJAMIN D GALLOSO
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Credential | LCSW, CAP, ACHT
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Telephone | 954-770-2363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | SW8346
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License Number State | FL
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