NPIMap

Organization Active NPI

Mindful Mediation LLC

  • Clinical Social Worker
  • North Haven, CT
National Provider Identifier
1891153474
Registry record updated Feb 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
008003 Issued in CT
Legal business name
MINDFUL MEDIATION LLC
Practice address
85 State St Ste D
North Haven, CT 06473-2240
Phone
(203) 376-0220
NPI assigned
Feb 10, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2016

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

Authorized official

Name
Shalyn Rose, LCSWNPI 1952650897
Title
Owner
Phone
(203) 376-0220

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 001770 CT
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 008003 CT Primary

Addresses

Primary practice location

85 State St Ste D
North Haven, CT 06473-2240

Mailing address

49 Englewood Dr
New Haven, CT 06515-2309

Other identifiers 2

IdentifierTypeStateIssuer
008041822MedicaidCT
008038021MedicaidCT

National Provider Directory

National Provider Directory

Locations

85 State St
Ste D
North Haven, CT 06473
Phone (203) 376-0220

Practitioners & affiliated clinicians

Practitioners 5

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": "1455062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455062400000",
    "number": "1891153474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 ENGLEWOOD DR",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065152309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 STATE ST STE D",
            "city": "NORTH HAVEN",
            "state": "CT",
            "postal_code": "064732240",
            "telephone_number": "203-376-0220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL MEDIATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-10",
        "last_updated": "2016-02-10",
        "status": "A",
        "authorized_official_last_name": "ROSE",
        "authorized_official_first_name": "SHALYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-376-0220",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "001770",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "008003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008041822",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008038021",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Haven, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2016; 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.