Provider Demographics
NPI:1104425420
Name:MINDFUL PATH THERAPY LLC
Entity type:Organization
Organization Name:MINDFUL PATH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:IOANILLI
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:781-888-6004
Mailing Address - Street 1:163 HIGHLAND AVE # 1057
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:163 HIGHLAND AVE # 1057
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3025
Practice Address - Country:US
Practice Address - Phone:978-540-5960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty