Mind Body Motherhood LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

MIND BODY MOTHERHOOD LLC

Practice address

649 Amity Rd Ste 103
Bethany, CT 06524-3091

Phone

(860) 357-1734

NPI assigned

May 13, 2020

Last updated

May 13, 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

Samantha Nilsson, LCSWNPI 1023314796

Title

Therapist and Owner

Phone

(860) 357-1734

Specialties & licenses 1

Addresses

Locations

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.

• Samantha Lynne Nilsson, LCSW

  • Clinical Social Worker
  • Waterbury, CT
  • NPI 1023314796
  NPD Authorized official

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

{
    "created_epoch": "1589328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589328000000",
    "number": "1770105736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 RICHARDSON DR",
            "city": "MIDDLEBURY",
            "state": "CT",
            "postal_code": "067622124",
            "telephone_number": "860-357-1734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "649 AMITY RD STE 103",
            "city": "BETHANY",
            "state": "CT",
            "postal_code": "065243091",
            "telephone_number": "860-357-1734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND BODY MOTHERHOOD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-13",
        "last_updated": "2020-05-13",
        "certification_date": "2020-05-13",
        "status": "A",
        "authorized_official_last_name": "NILSSON",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "THERAPIST AND OWNER",
        "authorized_official_telephone_number": "860-357-1734",
        "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 Bethany, CT
• Providers in Bethany, 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 May 13, 2020; 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.