Provider Demographics
NPI:1376429589
Name:MINDS AND MOTION WELLNESS LLC
Entity type:Organization
Organization Name:MINDS AND MOTION WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIPISA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-317-6005
Mailing Address - Street 1:67 FEDERAL RD
Mailing Address - Street 2:BUILDING A, SUITE 201
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804
Mailing Address - Country:US
Mailing Address - Phone:860-317-6005
Mailing Address - Fax:
Practice Address - Street 1:67 FEDERAL RD
Practice Address - Street 2:BUILDING A, SUITE 201
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-0680
Practice Address - Country:US
Practice Address - Phone:860-317-6005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)