Provider Demographics
NPI:1669049607
Name:PEACEFUL MINDS PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:PEACEFUL MINDS PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, CCATP
Authorized Official - Phone:732-239-5375
Mailing Address - Street 1:116 CRAIG RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3253
Mailing Address - Country:US
Mailing Address - Phone:848-757-6405
Mailing Address - Fax:
Practice Address - Street 1:116 CRAIG RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3253
Practice Address - Country:US
Practice Address - Phone:848-757-6405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)