Healthcare Provider Details

I. General information

NPI: 1083488134
Provider Name (Legal Business Name): BAKER STREET MIND HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 MADISON AVE STE 306
PARAMUS NJ
07652-2705
US

IV. Provider business mailing address

851 FRANKLIN LAKE RD STE 204
FRANKLIN LAKES NJ
07417-2267
US

V. Phone/Fax

Practice location:
  • Phone: 201-381-6136
  • Fax: 201-660-8271
Mailing address:
  • Phone: 201-381-6136
  • Fax: 201-660-8271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH GALASSO
Title or Position: PRESIDENT
Credential: PSYD
Phone: 201-381-6136