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General NPI Number Information
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NPI Number | 1740003425
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Entity Type | Organization
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Legal Business Name | FREE OF MIND PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 8 HILLSIDE AVE STE 207-1
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2129
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Country | US
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Telephone | 347-208-3313
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Fax |
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Provider Business Mailing Address
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Address Line | 30 FARRAND ST APT 423
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-4437
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Country | US
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Telephone | 347-208-3313
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Fax |
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Authorized Official
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Title or Position | FOUNDER/OWNER
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Name | DR. SHANTA KERINA PAMPHILE
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Credential | PHD, LPC, LMHC, NCC
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Telephone | 347-208-3313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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