Organization
MINDFUL THERAPY STUDIO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA BETH ROGERS LCSW (OWNER)
(860) 967-8941
Entity
Organization
Contact information
Practice address
11 WILDWOOD MEDICAL CENTER, ESSEX, CT 06426
(860) 967-8941
Mailing address
29 DAVIDSON RD, COLCHESTER, CT 06415-1601
(860) 967-8941
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
008520
CT
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1265742597
NPI 1
CT
Enumeration date
08/21/2018
Last updated
12/28/2024
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