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General NPI Number Information
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NPI Number | 1962857177
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Entity Type | Organization
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Legal Business Name | CHANGING MINDS
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 04/26/2016
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Provider Practice Location Address
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Address Line | 25 MAIN ST SUITE 220
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City | NORTHAMPTON
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State | MA
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Zip | 01060-3109
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Country | US
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Telephone | 413-834-7012
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Fax |
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Provider Business Mailing Address
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Address Line | 17 LONG AVE
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City | GREENFIELD
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State | MA
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Zip | 01301-1230
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | AMANDA MULLEN
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Credential | PSY.D.
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Telephone | 413-834-7012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 8231
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License Number State | MA
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