Provider Demographics
NPI:1669299145
Name:MINDFUL MEND THERAPY
Entity type:Organization
Organization Name:MINDFUL MEND THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:DANGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-600-7423
Mailing Address - Street 1:506 W MOUNT PLEASANT AVE # 1159
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1701
Mailing Address - Country:US
Mailing Address - Phone:973-600-7423
Mailing Address - Fax:973-440-3108
Practice Address - Street 1:31 VAN DUYNE AVE
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-4102
Practice Address - Country:US
Practice Address - Phone:973-600-7423
Practice Address - Fax:973-440-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty