Provider Demographics
NPI:1124918065
Name:GALLANT MINDS PSYCHIATRY
Entity type:Organization
Organization Name:GALLANT MINDS PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN-MARIE
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:640-204-5246
Mailing Address - Street 1:108 WATCHUNG AVE # 1010
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-1251
Mailing Address - Country:US
Mailing Address - Phone:640-204-5246
Mailing Address - Fax:
Practice Address - Street 1:108 WATCHUNG AVE # 1010
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-1251
Practice Address - Country:US
Practice Address - Phone:640-204-5246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty