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General NPI Number Information
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NPI Number | 1891674396
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Entity Type | Organization
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Legal Business Name | GROUNDED SPIRIT PSYCHOLOGY PLLC
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Dates
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Enumeration Date | 08/28/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 291 BROADWAY RM 1002
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City | NEW YORK
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State | NY
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Zip | 10007-1883
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Country | US
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Telephone | 914-256-2899
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Fax |
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Provider Business Mailing Address
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Address Line | 2005 PALMER AVE # 765
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City | LARCHMONT
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State | NY
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Zip | 10538-2437
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | GERALD PANTOJA
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Credential | PHD
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Telephone | 914-256-2899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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