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General NPI Number Information
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NPI Number | 1902195464
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Entity Type | Organization
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Legal Business Name | MENDING MINDS
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 24 SPRING VALLEY RD
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City | EAST LONGMEADOW
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State | MA
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Zip | 01028-2513
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Country | US
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Telephone | 413-530-3273
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Fax |
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Provider Business Mailing Address
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Address Line | 24 SPRING VALLEY RD
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City | EAST LONGMEADOW
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State | MA
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Zip | 01028-2513
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Country | US
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Telephone | 413-530-3273
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LAURIE KIMBALL
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Credential | APRN NP
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Telephone | 413-530-3273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 195411
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License Number State | MA
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