| The Mind And Body Consortium, Llc. | |
|
156 S State St Dover DE 19901-7314 | |
| (302) 674-2380 | |
| (302) 674-1299 |
| Full Name | The Mind And Body Consortium, Llc. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 156 S State St, Dover, Delaware |
| Authorized Official Name and Position | Lisa A Leidy (OWNER) |
| Authorized Official Contact | 3026742380 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Mind And Body Consortium, Llc. 156 S State St Dover DE 19901-7314 Ph: (302) 674-2380 | The Mind And Body Consortium, Llc. 156 S State St Dover DE 19901-7314 Ph: (302) 674-2380 |
| NPI Number | 1316186539 |
|---|---|
| Provider Enumeration Date | 02/11/2009 |
| Last Update Date | 02/09/2016 |
| Medicare PECOS PAC ID | 9739234014 |
|---|---|
| Medicare Enrollment ID | O20090910000340 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316186539 | NPI | - | NPPES |
| Provider Name | Imran Trimzi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467502773 PECOS PAC ID: 5698761773 Enrollment ID: I20040423000260 |
| Provider Name | Diana S Cohen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851404594 PECOS PAC ID: 0840276077 Enrollment ID: I20040628000802 |
| Provider Name | Ihuoma C Chuks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235417247 PECOS PAC ID: 9638141583 Enrollment ID: I20040811000026 |
| Provider Name | Cindy Cunningham |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1447277207 PECOS PAC ID: 5597765057 Enrollment ID: I20070105000442 |
| Provider Name | Nicholas A Brush |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700053162 PECOS PAC ID: 5890863476 Enrollment ID: I20081009000267 |
| Provider Name | Shelagh B Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477592517 PECOS PAC ID: 4385706001 Enrollment ID: I20081215000197 |
| Provider Name | Leah D Sullivan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003051244 PECOS PAC ID: 1254498116 Enrollment ID: I20090319000371 |
| Provider Name | David Kalkstein |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215923255 PECOS PAC ID: 6305851395 Enrollment ID: I20100114000433 |
| Provider Name | Deborah D Street |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730314949 PECOS PAC ID: 1052448339 Enrollment ID: I20101109001309 |
| Provider Name | Janet Urdahl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487798203 PECOS PAC ID: 3678750189 Enrollment ID: I20110610000064 |
| Provider Name | Grace J Rishell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508915356 PECOS PAC ID: 4183611528 Enrollment ID: I20120711000236 |
| Provider Name | Meriam E Chua |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922237643 PECOS PAC ID: 5496981458 Enrollment ID: I20131121000557 |
| Provider Name | Dee Ann L Widder |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346527967 PECOS PAC ID: 3072739416 Enrollment ID: I20140722000095 |
| Provider Name | Tamara D Walker-gladney |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1285046201 PECOS PAC ID: 3870711971 Enrollment ID: I20140903001147 |
| Provider Name | Anna Mclaughlin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679903348 PECOS PAC ID: 7214250505 Enrollment ID: I20141217001153 |
| Provider Name | Kristin Stonesifer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992113351 PECOS PAC ID: 8628391414 Enrollment ID: I20141231001677 |
| Provider Name | Joseph L Schwartz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1386707925 PECOS PAC ID: 1850489220 Enrollment ID: I20150304000994 |
| Provider Name | Hallie Katrina Dennison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568852358 PECOS PAC ID: 5890015317 Enrollment ID: I20160426001371 |
| Provider Name | Charles Jin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801966924 PECOS PAC ID: 1658329693 Enrollment ID: I20171019001265 |
| Provider Name | Joanna R Robertson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619483427 PECOS PAC ID: 2365799566 Enrollment ID: I20180719000136 |
| Provider Name | Michael Anthony Ditore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104535749 PECOS PAC ID: 5698133940 Enrollment ID: I20230620001459 |
| Provider Name | Azhar Bashma Waheed |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497033955 PECOS PAC ID: 9537527742 Enrollment ID: I20230621000695 |
| Provider Name | Kevin Peterson Daniels |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922726454 PECOS PAC ID: 1557717436 Enrollment ID: I20231030000307 |
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