| Go Mindful Practice, Llc | |
|
525 Route 73 N Ste 104 Marlton NJ 08053-3422 | |
| (646) 479-8068 | |
| Not Available |
| Full Name | Go Mindful Practice, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 525 Route 73 N Ste 104, Marlton, New Jersey |
| Authorized Official Name and Position | Jacqueline Shall-mccumiskey (OWNER) |
| Authorized Official Contact | 6464798068 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Go Mindful Practice, Llc 20 Haven Esplanade St Staten Island NY 10301-2717 Ph: (646) 479-8068 | Go Mindful Practice, Llc 525 Route 73 N Ste 104 Marlton NJ 08053-3422 Ph: (646) 479-8068 |
| NPI Number | 1508580937 |
|---|---|
| Provider Enumeration Date | 09/29/2022 |
| Last Update Date | 09/29/2022 |
| Certification Date | 09/29/2022 |
| Medicare PECOS PAC ID | 7214309921 |
|---|---|
| Medicare Enrollment ID | O20230207000019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508580937 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TB0200X | Psychologist - Cognitive & Behavioral | (* (Not Available)) | Primary |
| Provider Name | Jacqueline Shall Mccumiskey |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083160170 PECOS PAC ID: 5597043141 Enrollment ID: I20230207000025 |
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