Mystic Services, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

MYSTIC SERVICES, LLC

Doing business as

Mystic Bridge to Wellness

Practice address

47 Water St Ste 202
Mystic, CT 06355-2573

Phone

(617) 416-0597

Fax

(860) 415-0018

NPI assigned

Feb 2, 2020

Last updated

Feb 2, 2020By 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

Lauren E St. Amour, MSW, LCSWNPI 1659412153

Title

Licensed Clinical Social Worker

Phone

(617) 416-0597

Specialties & licenses 1

Addresses

Other names 1

• Mystic Bridge to Wellness Doing business as

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

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.

• Lauren E. St. Amour, LCSW

  • Clinical Social Worker
  • Mystic, CT
  • NPI 1659412153
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1580601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580601600000",
    "number": "1720619364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 JOYCE ST",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063552947",
            "telephone_number": "617-416-0597",
            "fax_number": "860-415-0018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 WATER ST STE 202",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063552573",
            "telephone_number": "617-416-0597",
            "fax_number": "860-415-0018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-02",
        "last_updated": "2020-02-02",
        "certification_date": "2020-02-02",
        "status": "A",
        "authorized_official_last_name": "ST. AMOUR",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "LICENSED CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "617-416-0597",
        "authorized_official_credential": "MSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mystic Bridge to Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mystic Healthcare & Rehabilitation Center LLC (Mystic Manor)
• Mystic Healthcare and Rehabilitation Facility
• Mystic Medical Associates LLC
• Mystic Medical Group, PC
• Mystic River Ambulance Association, Inc
• Mystic Spine & Sport LLC
• Mystic Therapy, LLC.
• Mystic Westerly Orthodontics, PC
• Natura Medica
• John Jeffrey Nelson, M.D.

• Community/Behavioral Health Agency in Mystic, CT
• Providers in Mystic, CT by specialty
• Community/Behavioral Health Agency in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2020; 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.