Mindful Life Psychotherapy LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

MINDFUL LIFE PSYCHOTHERAPY LLC

Practice address

200 Chauncy St Ste 113
Mansfield, MA 02048-1200

Phone

(508) 724-1025

Fax

(508) 552-9976

NPI assigned

Jan 16, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kathi Hennessey, LICSW

Title

Owner

Phone

(508) 784-1025

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kathleen Hennessey, LICSW

  • Clinical Social Worker
  • Mansfield, MA
  • NPI 1477883171
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688601600000",
    "number": "1003380684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CHAUNCY ST STE 113",
            "city": "MANSFIELD",
            "state": "MA",
            "postal_code": "020481200",
            "telephone_number": "508-724-1025",
            "fax_number": "508-552-9976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CHAUNCY ST STE 113",
            "city": "MANSFIELD",
            "state": "MA",
            "postal_code": "020481200",
            "telephone_number": "508-724-1025",
            "fax_number": "508-552-9976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL LIFE PSYCHOTHERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-16",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A",
        "authorized_official_last_name": "HENNESSEY",
        "authorized_official_first_name": "KATHI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-784-1025",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raegan McQuire
• Jodi Elizabeth Medeiros, JODI MEDEIROS LPN
• Julie Meelia
• Darlene A Menz, NP
• Grace Mimnaugh
• Mindgrove Health
• Christina Mitchell, CPNP-PC, PMHNP-BC
• Maryam Mohammadvali Samani, DMD
• Laura Monachino
• Bridget Monagle

• Clinical Social Worker in Mansfield, MA
• Providers in Mansfield, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.