| Mindbodysoulworks, Llc | |
|
4190 E Lake Rd Erie PA 16511-1355 | |
| (814) 616-2858 | |
| (814) 616-2860 |
| Full Name | Mindbodysoulworks, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4190 E Lake Rd, Erie, Pennsylvania |
| Authorized Official Name and Position | Mary Rudolph (THERAPIST/OWNER) |
| Authorized Official Contact | 8146162858 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindbodysoulworks, Llc 4190 E Lake Rd Erie PA 16511-1355 Ph: (814) 616-2858 | Mindbodysoulworks, Llc 4190 E Lake Rd Erie PA 16511-1355 Ph: (814) 616-2858 |
| NPI Number | 1205309531 |
|---|---|
| Provider Enumeration Date | 01/09/2019 |
| Last Update Date | 01/09/2019 |
| Medicare PECOS PAC ID | 8426399650 |
|---|---|
| Medicare Enrollment ID | O20190416001249 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205309531 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Mary E Rudolph |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174910855 PECOS PAC ID: 9335480565 Enrollment ID: I20190416001393 |
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