Mind Body Soul - Psychology and Consulting Group LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2706 Issued in CT

Legal business name

MIND BODY SOUL - PSYCHOLOGY AND CONSULTING GROUP LLC

Practice address

109 Danbury Road
Lower Level, Suite D6
Ridgefield, CT 06877-0687

Phone

(203) 494-8468

Fax

(845) 582-0764

NPI assigned

May 17, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Lori Wagner, PSYDNPI 1285902387

Title

Owner, Clinical Psychologist

Phone

(203) 494-8468

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lori Wagner, PSY.D.

  • Clinical Neuropsychologist
  • Ridgefield, CT
  • NPI 1285902387
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1494979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1912434234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 DANBURY ROAD",
            "address_2": "LOWER LEVEL, SUITE D6",
            "city": "RIDGEFIELD",
            "state": "CT",
            "postal_code": "06877",
            "telephone_number": "203-494-8468",
            "fax_number": "845-582-0764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 DANBURY ROAD",
            "address_2": "LOWER LEVEL, SUITE D6",
            "city": "RIDGEFIELD",
            "state": "CT",
            "postal_code": "068770687",
            "telephone_number": "203-494-8468",
            "fax_number": "845-582-0764"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "109 Danbury Rd Lowr Level",
            "address_purpose": "LOCATION",
            "city": "Ridgefield",
            "state": "CT",
            "postal_code": "068774142",
            "country_code": "US",
            "telephone_number": "203-494-8468",
            "fax_number": "845-582-0764",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MIND BODY SOUL - PSYCHOLOGY AND CONSULTING GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-17",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "OWNER, CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "203-494-8468",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "2706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Siobhan Meyer, APRN, FNP-BC
• Alexis Aslin Michael
• Carlos Powell Milla, DNP
• Jennifer Suzanne Miller, APRN
• Leo Albert Millette, M.D.
• Mindful Counseling LLC
• Modern Vascular, PLLC
• Stephen M Molinaro, DDS
• Astha Mootoo, LCSW
• Paolo Morena, MS, LPC

• Clinical Psychologist in Ridgefield, CT
• Providers in Ridgefield, CT by specialty
• Clinical Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.