Basic Information
| Provider Information | |||||||||
| NPI: | 1831581362 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | A SOUND MIND, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 988 NEW LONDON TPKE | ||||||||
| Address2: | |||||||||
| City: | GLASTONBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060335312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602624125 | ||||||||
| FaxNumber: | 2034229509 | ||||||||
| Practice Location | |||||||||
| Address1: | 988 NEW LONDON TPKE | ||||||||
| Address2: | |||||||||
| City: | GLASTONBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060335312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602624125 | ||||||||
| FaxNumber: | 2034229509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2015 | ||||||||
| LastUpdateDate: | 02/20/2015 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | ELEONORA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 8602624125 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 007838 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.