Organization
GO MINDFUL PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACQUELINE SHALL-MCCUMISKEY PSYD (OWNER)
(646) 479-8068
Entity
Organization
Contact information
Practice address
525 ROUTE 73 N STE 104, MARLTON, NJ 08053-3422
(646) 479-8068
Mailing address
20 HAVEN ESPLANADE ST, STATEN ISLAND, NY 10301-2717
(646) 479-8068
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
—
—
Other
Enumeration date
09/29/2022
Last updated
09/29/2022
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