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Organization
MINDFUL MEDIATION LLC
Active
Organization
MINDFUL MEDIATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHALYN ROSE LCSW (OWNER)
(203) 376-0220
Entity
Organization
Contact information
Practice address
85 STATE ST STE D, NORTH HAVEN, CT 06473-2240
(203) 376-0220
Mailing address
49 ENGLEWOOD DR, NEW HAVEN, CT 06515-2309
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
001770
CT
1041C0700X
Clinical Social Worker
Primary
008003
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008038021
—
CT
05
—
008041822
—
CT
Enumeration date
02/10/2016
Last updated
02/10/2016
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