MIND BODY MOTHERHOOD LLC (NPI# 1770105736) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770105736 |
| Entity Type | Organization |
| Organization Name | MIND BODY MOTHERHOOD LLC |
| Practice Address |
649 Amity Rd Ste 103 Bethany CT 06524-3091 |
| Mailing Address |
130 Richardson Dr Middlebury CT 06762-2124 |
| Practice Telephone | 8603571734 |
| Mailing Telephone | 8603571734 |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2020-05-13 |
| Authorized Official Name | SAMANTHA NILSSON (THERAPIST AND OWNER) |
| Authorized Official Telephone | 8603571734 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | Mind Body Motherhood LLC | 649 Amity Rd, Suite 103, Middlebury, CT 06762 |
| Street Address |
649 AMITY RD STE 103 |
| City | BETHANY |
| State | CT |
| Zip Code | 06524-3091 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194378323 | Brittany Varano | Dental Hygienist | 55 Sargent Dr., Bethany, CT 06524 | 2019-07-17 |
| 1366952384 | Cybil Kathleen Ryan | Social Worker | 649 Amity Rd # Uni103, Bethany, CT 06524 | 2017-10-04 |
| 1952542409 | Deborah Lynn Ellsworth | Social Worker | 649 Amity Road, Bethany, CT 06524 | 2009-03-12 |
| 1730218181 | Boaz Itshaky | Acupuncturist | 286 Beacon Rd, Bethany, CT 06524 | 2007-03-03 |
| 1881750131 | Michael Bruce Enson | Social Worker | 9 Munson Road, 2nd Floor, Bethany, CT 06524 | 2006-12-29 |
| 1043327232 | Amity Dental Care Inc | Dentist | 696 Amity Rd Ste A3, Bethany, CT 06524-3006 | 2006-08-24 |
| 1770805301 | Annette Maria Snow | Dietitian, Registered | 54 Lacey Rd, Bethany, CT 06524-3021 | 2010-02-24 |
| 1679561120 | The Bethany Volunteer Firemens Association Incorporated | Ambulance | 765 Amity Rd, Bethany, CT 06524-3028 | 2005-10-10 |
| 1538458310 | Pediatric Parenting, LLC | Nurse Practitioner | 435 Amity Rd, Bethany, CT 06524-3038 | 2011-04-01 |
| 1831639392 | Tatiana A. Goclowski | Nurse Practitioner | 187 Beacon Rd, Bethany, CT 06524-3054 | 2017-03-03 |
| Find all providers in zip 06524 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992261788 | Linda Vandivert | Social Worker | 20552 W 340th St, Bethany, MO 64424-8335 | 2019-02-16 |
| 1366952384 | Cybil Kathleen Ryan | Social Worker | 649 Amity Rd # Uni103, Bethany, CT 06524 | 2017-10-04 |
| 1306390943 | Alanna Voloshin | Social Worker | 53 Brookwood Rd, Bethany, CT 06524-3148 | 2016-08-11 |
| 1285188482 | Alexandra Migani | Social Worker | 649 Amity Rd Unit 103, Bethany, CT 06524-3091 | 2016-08-05 |
| 1407269699 | Nick Demaio IIi | Social Worker | 46 Rolling Green Rd, Bethany, CT 06524-3321 | 2014-06-05 |
| 1396017117 | Michelle Keeslerconnor | Social Worker | 649 Amity Rd Unit 102, Bethany, CT 06524-3091 | 2012-02-09 |
| 1952542409 | Deborah Lynn Ellsworth | Social Worker | 649 Amity Road, Bethany, CT 06524 | 2009-03-12 |
| 1952540528 | Cari Lauren Medwin | Social Worker | 15 Woods Rd, Bethany, CT 06524-3103 | 2009-02-05 |
| 1417193269 | Marilyn Marie Mckenzie | Social Worker | 8020 Nw 27th St, Bethany, OK 73008-4815 | 2008-12-29 |
| 1376739946 | Cynthia Sue Butler | Social Worker | 4118 Miller St, Bethany, MO 64424 | 2007-09-18 |
| Find all providers in BETHANY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.