Healthcare Provider Details

I. General information

NPI: 1255048583
Provider Name (Legal Business Name): PEACE OF MIND PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 WESTWOOD AVE
RIVER VALE NJ
07675-6295
US

IV. Provider business mailing address

549 WESTWOOD AVE
RIVER VALE NJ
07675-5540
US

V. Phone/Fax

Practice location:
  • Phone: 201-822-1202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRETT BERSANO
Title or Position: OWNER
Credential: PSYD
Phone: 201-822-1202