Mindful Self Care Therapy, Llc | |
46 Underwood Dr West Orange NJ 07052-1323 | |
(973) 820-5174 | |
Not Available |
Full Name | Mindful Self Care Therapy, Llc |
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Speciality | Psychologist |
Location | 46 Underwood Dr, West Orange, New Jersey |
Authorized Official Name and Position | Debra S Gill (OWNER) |
Authorized Official Contact | 9738205174 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Mindful Self Care Therapy, Llc 7140 Prosperity Cir Sarasota FL 34238-1503 Ph: (973) 820-5174 | Mindful Self Care Therapy, Llc 46 Underwood Dr West Orange NJ 07052-1323 Ph: (973) 820-5174 |
NPI Number | 1205594108 |
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Provider Enumeration Date | 12/08/2021 |
Last Update Date | 12/08/2021 |
Certification Date | 12/08/2021 |
Medicare PECOS PAC ID | 1456746676 |
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Medicare Enrollment ID | O20220324001094 |
Identifier | Type | State | Issuer |
---|---|---|---|
1205594108 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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103T00000X | Psychologist | (* (Not Available)) | Primary |
Provider Name | Debra Shapiro Gill |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1265669378 PECOS PAC ID: 8325191463 Enrollment ID: I20090806000468 |
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