Healthcare Provider Details

I. General information

NPI: 1235723321
Provider Name (Legal Business Name): MIND OVER MATTER PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 NORTH AVE OFC 18
WAKEFIELD MA
01880-1306
US

IV. Provider business mailing address

9793 W SAMPLE RD
CORAL SPRINGS FL
33065-4003
US

V. Phone/Fax

Practice location:
  • Phone: 781-705-0567
  • Fax: 623-666-6792
Mailing address:
  • Phone: 781-705-0567
  • Fax: 623-666-6792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JESSICA RAMALHO GOULART
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 781-705-0567