Provider Demographics
NPI:1205594108
Name:MINDFUL SELF CARE THERAPY, LLC
Entity type:Organization
Organization Name:MINDFUL SELF CARE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-820-5174
Mailing Address - Street 1:7140 PROSPERITY CIR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-1503
Mailing Address - Country:US
Mailing Address - Phone:973-820-5174
Mailing Address - Fax:
Practice Address - Street 1:46 UNDERWOOD DR
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1323
Practice Address - Country:US
Practice Address - Phone:973-820-5174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty