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General NPI Number Information
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NPI Number | 1780143693
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Entity Type | Organization
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Legal Business Name | MINDFULLY MINE COUNSELING CENTER
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 179 S MAPLE AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-4541
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Country | US
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Telephone | 201-266-3087
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Fax | 201-462-3916
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Provider Business Mailing Address
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Address Line | 179 S MAPLE AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-4541
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Country | US
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Telephone | 201-266-3087
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Fax | 201-462-3916
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Authorized Official
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Title or Position | FOUNDER/CLINICAL DIRECTOR
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Name | DR. ANDREA GLEIM
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Credential | PSY.D.,
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Telephone | 201-266-3087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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