Shanta Kerina Pamphile, MA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

18P01042 Issued in NY

Practice address

5676 Riverdale Ave
Suite 202
Bronx, NY 10471-2138

Phone

(718) 796-5300

NPI assigned

Dec 20, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Free of Mind Psychotherapy LLC

  • Mental Health Counselor
  • Montclair, NJ
  • NPI 1740003425
  NPD Authorized official

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

{
    "created_epoch": "1482192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482192000000",
    "number": "1295270791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1438 TAYLOR AVE",
            "address_2": "APT 1",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104603774",
            "telephone_number": "347-208-3313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5676 RIVERDALE AVE",
            "address_2": "SUITE 202",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104712138",
            "telephone_number": "718-796-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAMPHILE",
        "first_name": "SHANTA",
        "middle_name": "KERINA",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-20",
        "last_updated": "2016-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "18P01042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18P01042",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kieran Elliot Palumbo
• Pambo Medical Neuro-Rehabilitation PC
• Vahila Pamidimukkala
• Alexandra Grace Pamiloza, MPH, CHES
• Tomas Pamparas
• Michael Pamplona, PA
• Ethan Pan
• Jing-Yu Pan, M.D.
• Marc Huang Pan, D.M.D, MD
• Xinyue Pan, MD

• Mental Health Counselor in Bronx, NY
• Providers in Bronx, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.