Healthcare Provider Details

I. General information

NPI: 1891674396
Provider Name (Legal Business Name): GROUNDED SPIRIT PSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 5TH AVE RM 1002
NEW YORK NY
10016-6639
US

IV. Provider business mailing address

2005 PALMER AVE # 765
LARCHMONT NY
10538-2437
US

V. Phone/Fax

Practice location:
  • Phone: 914-256-2899
  • Fax: 914-222-8974
Mailing address:
  • Phone: 914-256-2899
  • Fax: 914-222-8974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GERALD PANTOJA
Title or Position: FOUNDER
Credential: PHD
Phone: 914-256-2899