Misfit Mamas, Inc.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

MISFIT MAMAS, INC.

Practice address

135 Lake Ave
Bristol, CT 06010-7318

Phone

(860) 222-0831

NPI assigned

Jan 19, 2024

Last updated

Feb 7, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Leslie Sobieraj, LCSW

Title

Behavioral Health Director

Phone

(310) 991-0939

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1705622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707264000000",
    "number": "1336900901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 629",
            "city": "SOUTHINGTON",
            "state": "CT",
            "postal_code": "064890629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 LAKE AVE",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060107318",
            "telephone_number": "860-222-0831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISFIT MAMAS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-19",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A",
        "authorized_official_last_name": "SOBIERAJ",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "BEHAVIORAL HEALTH DIRECTOR",
        "authorized_official_telephone_number": "310-991-0939",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Bristol, CT
• Providers in Bristol, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.