NPIMap

Organization Active NPI

Mindful Haven LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Newark, DE
National Provider Identifier
1568325546
Registry record updated Dec 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
MINDFUL HAVEN LLC
Practice address
630 Churchmans Rd Ste 106
Newark, DE 19702-1943
Phone
(410) 630-8292
NPI assigned
Dec 5, 2025
Last updated
Dec 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2025

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

Authorized official

Name
Latoya VictorNPI 1538559778
Title
Co-Owner
Phone
(667) 204-7300

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
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary

Addresses

Primary practice location

630 Churchmans Rd Ste 106
Newark, DE 19702-1943

Mailing address

200 Continental Dr Ste 401
Newark, DE 19713-4337

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260311000195 DE Part B Supplier - Clinic/Group Practice 6507300910 Receives reassigned benefits from 2 practitioners
Practice locations: Newark, DE

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Mindful Haven 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.

Locations

630 Churchmans Rd
Ste 106
Newark, DE 19702
Phone (410) 630-8292

9524 Belair Rd
Nottingham, MD 21236
Phone (410) 529-9311

Practitioners & affiliated clinicians

Practitioners 3

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": "1764892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765756800000",
    "number": "1568325546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CONTINENTAL DR STE 401",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197134337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 CHURCHMANS RD STE 106",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197021943",
            "telephone_number": "410-630-8292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL HAVEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-05",
        "last_updated": "2025-12-15",
        "certification_date": "2025-12-15",
        "status": "A",
        "authorized_official_last_name": "VICTOR",
        "authorized_official_first_name": "LATOYA",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "667-204-7300"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.