Provider Demographics
NPI:1285266882
Name:BALANCED MIND COUNSELING AND WELLNESS
Entity type:Organization
Organization Name:BALANCED MIND COUNSELING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PROVENZANO
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-378-0966
Mailing Address - Street 1:218 LITTLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COTUIT
Mailing Address - State:MA
Mailing Address - Zip Code:02635-2805
Mailing Address - Country:US
Mailing Address - Phone:401-378-0966
Mailing Address - Fax:
Practice Address - Street 1:2 OAK STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649
Practice Address - Country:US
Practice Address - Phone:401-378-0966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty