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General NPI Number Information
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NPI Number | 1942881933
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Entity Type | Organization
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Legal Business Name | MINDFUL INTEGRATIVE SERVICES
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Dates
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Enumeration Date | 04/20/2021
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 1389 W MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06708-3104
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Country | US
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Telephone | 203-687-5668
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Fax | 203-729-4444
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Provider Business Mailing Address
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Address Line | 1389 W MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06708-3104
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Country | US
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Telephone | 203-687-5668
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Fax | 203-729-4444
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTITIONER
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Name | SHIRLEY JOSEPH
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Credential | APRN
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Telephone | 203-687-5668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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