NPIMap

Organization Active NPI

Rejuvenating Mind & Body , LLC

  • Clinical Social Worker
  • Waterbury, CT
National Provider Identifier
1861924292
Registry record updated Apr 26, 2017
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Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
009126 Issued in CT
Legal business name
REJUVENATING MIND & BODY , LLC
Practice address
969 W Main St
Suite 2G
Waterbury, CT 06708-2653
Phone
(203) 625-1502
NPI assigned
Apr 3, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2017

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

Authorized official

Name
Jody Lynn Zenkus, LCSW
Title
Licensed Clinical Social Worker
Phone
(203) 535-7388

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 009126 CT Primary

Addresses

Primary practice location

969 W Main St
Suite 2G
Waterbury, CT 06708-2653

Mailing address

969 W Main St
Suite 2G
Waterbury, CT 06708-2653
Phone (203) 625-1502

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1491177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493164800000",
    "number": "1861924292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "969 W MAIN ST",
            "address_2": "SUITE 2G",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082653",
            "telephone_number": "203-625-1502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "969 W MAIN ST",
            "address_2": "SUITE 2G",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082653",
            "telephone_number": "203-625-1502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REJUVENATING MIND & BODY , LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-03",
        "last_updated": "2017-04-26",
        "status": "A",
        "authorized_official_last_name": "ZENKUS",
        "authorized_official_first_name": "JODY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "LICENSED CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "203-535-7388",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "009126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2017; 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.