NPIMap

Organization Active NPI

Mindful Therapy Studio LLC

Doing business as The Mindful Therapy Studio

  • Clinical Social Worker
  • Moodus, CT
National Provider Identifier
1447894209
Registry record updated Nov 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MINDFUL THERAPY STUDIO LLC
Doing business as
The Mindful Therapy Studio
Practice address
16 Rae Palmer Rd
Moodus, CT 06469-1195
Phone
(860) 967-8941
NPI assigned
Nov 4, 2019
Last updated
Nov 4, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2019

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

Authorized official

Name
Lisa Rogers, LCSWNPI 1265742597
Title
Owner/Operator
Phone
(860) 967-8941

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

16 Rae Palmer Rd
Moodus, CT 06469-1195

Mailing address

16 Rae Palmer Rd
Moodus, CT 06469-1195
Phone (860) 967-8941

Other identifiers 1

IdentifierTypeStateIssuer
047660231MedicaidCT

Other names 1

  • The Mindful Therapy Studio Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mindful Therapy Studio LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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": "1572825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572825600000",
    "number": "1447894209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 RAE PALMER RD",
            "city": "MOODUS",
            "state": "CT",
            "postal_code": "064691195",
            "telephone_number": "860-967-8941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 RAE PALMER RD",
            "city": "MOODUS",
            "state": "CT",
            "postal_code": "064691195",
            "telephone_number": "860-967-8941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL THERAPY STUDIO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-04",
        "last_updated": "2019-11-04",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "860-967-8941",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "047660231",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Mindful Therapy Studio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moodus, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2019; 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.