Organization Active NPI

Mind and Body Balanced LLC

  • Psychiatry Physician
  • Prospect, CT
National Provider Identifier
1487519807
Registry record updated Dec 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MIND AND BODY BALANCED LLC
Practice address
47 Waterbury Rd Ste 322
Prospect, CT 06712-1256
Phone
(914) 252-3976
Fax
(914) 416-5658
NPI assigned
Dec 18, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2025

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

Authorized official

Name
Cassandra Lucy Williams, NPNPI 1851796957
Title
Nurse Practitioner
Phone
(914) 252-3976

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
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

47 Waterbury Rd Ste 322
Prospect, CT 06712-1256

Mailing address

47 Waterbury Rd Ste 322
Prospect, CT 06712-1256
Phone (914) 252-3976

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20260504007075 CT Part B Supplier - Clinic/Group Practice 3678041142 Receives reassigned benefits from 1 practitioner
Practice locations: Prospect, CT
O20260504007568 NY Part B Supplier - Clinic/Group Practice 3678041142 Receives reassigned benefits from 1 practitioner
Practice locations: Mount Vernon, NY

National Provider Directory

National Provider Directory

Locations

47 Waterbury Rd
Ste 322
Prospect, CT 06712
Phone (914) 252-3976

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1766016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766016000000",
    "number": "1487519807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 WATERBURY RD STE 322",
            "city": "PROSPECT",
            "state": "CT",
            "postal_code": "067121256",
            "telephone_number": "914-252-3976",
            "fax_number": "914-416-5658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 WATERBURY RD STE 322",
            "city": "PROSPECT",
            "state": "CT",
            "postal_code": "067121256",
            "telephone_number": "914-252-3976",
            "fax_number": "914-416-5658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND AND BODY BALANCED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-18",
        "last_updated": "2025-12-18",
        "certification_date": "2025-12-18",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_middle_name": "LUCY",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "914-252-3976",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prospect, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 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.