Provider Demographics
NPI:1740003425
Name:FREE OF MIND PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:FREE OF MIND PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANTA
Authorized Official - Middle Name:KERINA
Authorized Official - Last Name:PAMPHILE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, LMHC, NCC
Authorized Official - Phone:347-208-3313
Mailing Address - Street 1:30 FARRAND ST APT 423
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4437
Mailing Address - Country:US
Mailing Address - Phone:347-208-3313
Mailing Address - Fax:
Practice Address - Street 1:8 HILLSIDE AVE STE 207-1
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2129
Practice Address - Country:US
Practice Address - Phone:347-208-3313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty