MEDICARE: MINDFUL MAVENS, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1144188822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL MAVENS, LLC.

Provider Business Mailing Address
First Line	:	734 WATERSIDE DR
Second Line	:
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-3715
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	734 WATERSIDE DR
Second Line	:
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-3715
Country	:	US
Telephone Number	:	815-994-8916
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PRATIP NAG
Credential	:	MD
Telephone Number	:	815-994-8916

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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