NPIMap

Organization Active NPI

Mindful Counseling Center LLC

  • Clinical Social Worker
  • Egg Harbor Township, NJ
National Provider Identifier
1164832192
Registry record updated Jan 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
44SC05182000 Issued in NJ
Legal business name
MINDFUL COUNSELING CENTER LLC
Practice address
3069 English Creek Ave
Suite 224
Egg Harbor Township, NJ 08234-9708
Phone
(609) 780-3570
NPI assigned
Apr 29, 2014
Last updated
Jan 26, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2019

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

Authorized official

Name
Mr. Patrick R Connelly, LCSWNPI 1417016908
Title
Owner
Phone
(609) 780-3570

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 44SC05182000 NJ Primary

Addresses

Primary practice location

3069 English Creek Ave
Suite 224
Egg Harbor Township, NJ 08234-9708

Mailing address

3069 English Creek Ave
Suite 224
Egg Harbor Township, NJ 08234-9708
Phone (609) 780-3570

Other names 1

  • Mindful Counseling Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190212000235 NJ Part B Supplier - Clinic/Group Practice 7719225077 Receives reassigned benefits from 8 practitioners
Practice locations: Egg HBR TWP, NJ

National Provider Directory

National Provider Directory

Locations

3069 English Creek Ave
Ste 224
Egg Hbr Twp, NJ 08234
Phone (609) 377-5859

Practitioners & affiliated clinicians

Practitioners 9

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": "1398729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548460800000",
    "number": "1164832192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3069 ENGLISH CREEK AVE",
            "address_2": "SUITE 224",
            "city": "EGG HARBOR TOWNSHIP",
            "state": "NJ",
            "postal_code": "082349708",
            "telephone_number": "609-780-3570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3069 ENGLISH CREEK AVE",
            "address_2": "SUITE 224",
            "city": "EGG HARBOR TOWNSHIP",
            "state": "NJ",
            "postal_code": "082349708",
            "telephone_number": "609-780-3570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL COUNSELING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-29",
        "last_updated": "2019-01-26",
        "status": "A",
        "authorized_official_last_name": "CONNELLY",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "609-780-3570",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05182000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mindful Counseling Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Egg Harbor Township, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2019; 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.