Provider Demographics
NPI:1871809624
Name:PEACE OF MINDFULLNESS, INC
Entity type:Organization
Organization Name:PEACE OF MINDFULLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLBURT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-874-2022
Mailing Address - Street 1:12 BREARLY CRES
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3553
Mailing Address - Country:US
Mailing Address - Phone:201-874-2022
Mailing Address - Fax:
Practice Address - Street 1:12 BREARLY CRES
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3553
Practice Address - Country:US
Practice Address - Phone:201-874-2022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053668001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty