Healthcare Provider Details

I. General information

NPI: 1780143693
Provider Name (Legal Business Name): MINDFULLY MINE COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 S MAPLE AVE
RIDGEWOOD NJ
07450-4541
US

IV. Provider business mailing address

179 S MAPLE AVE
RIDGEWOOD NJ
07450-4541
US

V. Phone/Fax

Practice location:
  • Phone: 201-266-3087
  • Fax: 201-462-3916
Mailing address:
  • Phone: 201-266-3087
  • Fax: 201-462-3916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREA GLEIM
Title or Position: FOUNDER/CLINICAL DIRECTOR
Credential: PSY.D.,
Phone: 201-266-3087