Provider Demographics
NPI:1659163913
Name:NORTH SHORE MINDFUL LLC
Entity type:Organization
Organization Name:NORTH SHORE MINDFUL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:D'ANTILIO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:617-212-0304
Mailing Address - Street 1:65 DODGE ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1700
Mailing Address - Country:US
Mailing Address - Phone:617-212-0304
Mailing Address - Fax:978-607-4130
Practice Address - Street 1:5 BROADWAY STE 300
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-1057
Practice Address - Country:US
Practice Address - Phone:617-212-0304
Practice Address - Fax:978-238-8543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)