Provider Demographics
NPI:1861150997
Name:ONEMINDONEBODYONESOULONEG-D, LLC
Entity type:Organization
Organization Name:ONEMINDONEBODYONESOULONEG-D, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST / OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:SOARES
Authorized Official - Last Name:VALENTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:475-999-2180
Mailing Address - Street 1:95 ROBERT TREAT DR APT B
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-8342
Mailing Address - Country:US
Mailing Address - Phone:475-999-2180
Mailing Address - Fax:
Practice Address - Street 1:1506 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5916
Practice Address - Country:US
Practice Address - Phone:475-999-2180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty