Healthcare Provider Details
I. General information
NPI: 1831047836
Provider Name (Legal Business Name): EDEN MINDSHIFT STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
6 OLD FORGE LN
EWING NJ
08618-1016
US
IV. Provider business mailing address
6 OLD FORGE LN
EWING NJ
08618-1016
US
V. Phone/Fax
- Phone: 609-684-8937
- Fax: 609-809-1845
- Phone: 609-684-8937
- Fax: 609-809-1845
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
EDEN
RICHMAN
Title or Position: OWNER
Credential: LCSW
Phone: 609-684-8937