Organization
BALANCED MIND COUNSELING AND WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE PROVENZANO LICSW (OWNER)
(401) 378-0966
Entity
Organization
Contact information
Practice address
2 OAK STREET, SUITE 201, MASHPEE, MA 02649
(401) 378-0966
Mailing address
218 LITTLE RIVER RD, COTUIT, MA 02635-2805
(401) 378-0966
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
02/11/2020
Last updated
05/27/2020
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