NPIMap

Organization Active NPI

Mind Body Rise

  • Clinical Social Worker
  • Stonington, CT
National Provider Identifier
1003481755
Registry record updated Jul 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MIND BODY RISE
Practice address
808 Stonington Rd Ste 200
Stonington, CT 06378-2517
Phone
(860) 535-9922
NPI assigned
May 25, 2021
Last updated
Jul 1, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2025

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

Authorized official

Name
Terri Fogg Donovan
Title
Owner
Phone
(860) 912-9584

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU Primary

Addresses

Primary practice location

808 Stonington Rd Ste 200
Stonington, CT 06378-2517

Mailing address

808 Stonington Rd
Stonington, CT 06378-2530
Phone (860) 535-9922

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210908001574 CT Part B Supplier - Clinic/Group Practice 6800292343 Receives reassigned benefits from 12 practitioners
Practice locations: Stonington, CT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1621900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751328000000",
    "number": "1003481755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 STONINGTON RD",
            "city": "STONINGTON",
            "state": "CT",
            "postal_code": "063782530",
            "telephone_number": "860-535-9922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 STONINGTON RD STE 200",
            "city": "STONINGTON",
            "state": "CT",
            "postal_code": "063782517",
            "telephone_number": "860-535-9922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND BODY RISE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-25",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "status": "A",
        "authorized_official_last_name": "FOGG DONOVAN",
        "authorized_official_first_name": "TERRI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-912-9584"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stonington, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2025; 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.