Provider Demographics
NPI:1912594268
Name:PEACEFUL PSYCHIATRY, LLC
Entity Type:Organization
Organization Name:PEACEFUL PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMBIESKI
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:631-807-3126
Mailing Address - Street 1:116 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4226
Mailing Address - Country:US
Mailing Address - Phone:631-807-3126
Mailing Address - Fax:203-265-3651
Practice Address - Street 1:116 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4226
Practice Address - Country:US
Practice Address - Phone:631-807-3126
Practice Address - Fax:203-265-3651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health