| Mindful Life Psychotherapy Llc | |
|
200 Chauncy St Ste 113 Mansfield MA 02048-1200 | |
| (508) 724-1025 | |
| (508) 552-9976 |
| Full Name | Mindful Life Psychotherapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 200 Chauncy St Ste 113, Mansfield, Massachusetts |
| Authorized Official Name and Position | Kathi Hennessey (OWNER) |
| Authorized Official Contact | 5087841025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindful Life Psychotherapy Llc 200 Chauncy St Ste 113 Mansfield MA 02048-1200 Ph: (508) 724-1025 | Mindful Life Psychotherapy Llc 200 Chauncy St Ste 113 Mansfield MA 02048-1200 Ph: (508) 724-1025 |
| NPI Number | 1003380684 |
|---|---|
| Provider Enumeration Date | 01/16/2019 |
| Last Update Date | 07/06/2023 |
| Certification Date | 07/06/2023 |
| Medicare PECOS PAC ID | 5395108807 |
|---|---|
| Medicare Enrollment ID | O20230831001736 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003380684 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kathleen A Hennessey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477883171 PECOS PAC ID: 3971768177 Enrollment ID: I20120712000523 |
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