| Mind Body Rise | |
|
808 Stonington Rd Stonington CT 06378-2530 | |
| (860) 535-9922 | |
| Not Available |
| Full Name | Mind Body Rise |
|---|---|
| Speciality | Social Worker |
| Location | 808 Stonington Rd, Stonington, Connecticut |
| Authorized Official Name and Position | Terri Fogg Donovan (OWNER) |
| Authorized Official Contact | 8609129584 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Body Rise 808 Stonington Rd Stonington CT 06378-2530 Ph: (860) 535-9922 | Mind Body Rise 808 Stonington Rd Stonington CT 06378-2530 Ph: (860) 535-9922 |
| NPI Number | 1003481755 |
|---|---|
| Provider Enumeration Date | 05/25/2021 |
| Last Update Date | 11/04/2021 |
| Certification Date | 11/04/2021 |
| Medicare PECOS PAC ID | 6800292343 |
|---|---|
| Medicare Enrollment ID | O20210908001574 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003481755 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Pamela E Mirante |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003940917 PECOS PAC ID: 9931371747 Enrollment ID: I20111020000005 |
| Provider Name | Cynthia A Palma |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649466590 PECOS PAC ID: 9032353875 Enrollment ID: I20170907001549 |
| Provider Name | Linda Cunningham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043809411 PECOS PAC ID: 6406252550 Enrollment ID: I20210915001069 |
| Provider Name | Susan J Donovan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386317774 PECOS PAC ID: 3375924525 Enrollment ID: I20220719001788 |
| Provider Name | Nancy Pearce |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831871953 PECOS PAC ID: 0547615320 Enrollment ID: I20231013002576 |
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