Provider Demographics
NPI:1255141636
Name:INNER MIND DEVELOPMENT GROUP, LLC
Entity type:Organization
Organization Name:INNER MIND DEVELOPMENT GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENNA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:GILOT
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:857-203-7001
Mailing Address - Street 1:PO BOX 260366
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02126-0007
Mailing Address - Country:US
Mailing Address - Phone:857-203-7001
Mailing Address - Fax:
Practice Address - Street 1:34 RIDGEVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02126-2538
Practice Address - Country:US
Practice Address - Phone:857-719-2236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty