Mindful Self Care Therapy, LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

MINDFUL SELF CARE THERAPY, LLC

Practice address

46 Underwood Dr
West Orange, NJ 07052-1323

Phone

(973) 820-5174

NPI assigned

Dec 8, 2021

Last updated

Dec 8, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Debra S Gill, PHDNPI 1265669378

Title

Owner

Phone

(973) 820-5174

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Debra Shapiro Gill, PH.D.

  • Clinical Psychologist
  • Livingston, NJ
  • NPI 1265669378
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638921600000",
    "number": "1205594108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7140 PROSPERITY CIR",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342381503",
            "telephone_number": "973-820-5174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 UNDERWOOD DR",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070521323",
            "telephone_number": "973-820-5174"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7140 Prosperity Cir",
            "address_purpose": "LOCATION",
            "city": "Sarasota",
            "state": "FL",
            "postal_code": "342381503",
            "country_code": "US",
            "telephone_number": "973-820-5174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MINDFUL SELF CARE THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-08",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A",
        "authorized_official_last_name": "GILL",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-820-5174",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lincoln Miller, MD
• Michele Miller
• Nicole Miller, PA-C
• Samuel J Miller
• Mind and Match New Jersey, P.C.
• Miracle Homecare Physical Therapy LLC
• Vivian Marina Miranda, LAMFT
• Robert G. Mirsky, MD
• Geetanjali Mishra
• Amit Misra, M.D.

• Psychologist in West Orange, NJ
• Providers in West Orange, NJ by specialty
• Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.