Provider Demographics
NPI:1023659976
Name:MY PLACE FOR PEACE, LLC
Entity type:Organization
Organization Name:MY PLACE FOR PEACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:BERGACS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-751-1208
Mailing Address - Street 1:84 PARK AVE STE E114
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-1176
Mailing Address - Country:US
Mailing Address - Phone:908-751-1208
Mailing Address - Fax:908-824-2369
Practice Address - Street 1:84 PARK AVE STE E114
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1176
Practice Address - Country:US
Practice Address - Phone:908-751-1208
Practice Address - Fax:908-824-2369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty