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General NPI Number Information
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NPI Number | 1295124477
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Entity Type | Organization
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Legal Business Name | NEWMIND PSYCHOLOGY SERVICES LLC
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 01/24/2019
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Provider Practice Location Address
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Address Line | 6601 VENTNOR AVE, STE 16 B
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City | VENTNOR CITY
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State | NJ
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Zip | 08406-0840
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Country | US
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Telephone | 269-876-9694
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Fax |
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Provider Business Mailing Address
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Address Line | 505 HAMILTON AVE SUITE 102
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City | LINWOOD
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State | NJ
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Zip | 08221-1057
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Country | US
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Telephone | 269-876-9694
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANA ISABEL PLACENCIA-BLOCK
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Credential | LCSW
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Telephone | 269-876-9694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05508700
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License Number State | NJ
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