| Mind Body Counseling Llc | |
|
352 Main St Durham CT 06422-1645 | |
| (860) 373-2828 | |
| Not Available |
| Full Name | Mind Body Counseling Llc |
|---|---|
| Speciality | Counselor |
| Location | 352 Main St, Durham, Connecticut |
| Authorized Official Name and Position | Marisa Valdiserra (OWNER) |
| Authorized Official Contact | 8603732828 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Body Counseling Llc 100 Hunting Hill Ave Middletown CT 06457-4314 Ph: (860) 373-2828 | Mind Body Counseling Llc 352 Main St Durham CT 06422-1645 Ph: (860) 373-2828 |
| NPI Number | 1578029377 |
|---|---|
| Provider Enumeration Date | 02/16/2019 |
| Last Update Date | 02/16/2019 |
| Medicare PECOS PAC ID | 6204276637 |
|---|---|
| Medicare Enrollment ID | O20240501003455 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578029377 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Marisa L Valdiserra |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598001380 PECOS PAC ID: 7012357445 Enrollment ID: I20240501003612 |
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