Provider Demographics
NPI:1720798317
Name:BE MINDFUL CLINIC LLC
Entity type:Organization
Organization Name:BE MINDFUL CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:TANESHA
Authorized Official - Middle Name:SHAREE
Authorized Official - Last Name:PICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-268-9558
Mailing Address - Street 1:50 MERRIMAN RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1065
Mailing Address - Country:US
Mailing Address - Phone:860-268-9558
Mailing Address - Fax:
Practice Address - Street 1:50 MERRIMAN RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-1065
Practice Address - Country:US
Practice Address - Phone:860-268-9558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty