Provider Demographics
NPI:1861924292
Name:REJUVENATING MIND & BODY , LLC
Entity type:Organization
Organization Name:REJUVENATING MIND & BODY , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ZENKUS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-535-7388
Mailing Address - Street 1:969 W MAIN ST
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2653
Mailing Address - Country:US
Mailing Address - Phone:203-625-1502
Mailing Address - Fax:
Practice Address - Street 1:969 W MAIN ST
Practice Address - Street 2:SUITE 2G
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2653
Practice Address - Country:US
Practice Address - Phone:203-625-1502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0091261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty