MEDICARE: JACKLYN ANN CIMINO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	098559	NY
2	104100000X	Social Worker	104419-1	NY

General Provider Information

NPI Number	:	1881259018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKLYN ANN CIMINO LCSW

Provider Business Mailing Address
First Line	:	31 GAYNOR AVE
Second Line	:
City	:	NESCONSET
State	:	NY
Zip	:	11767-1838
Country	:	US
Telephone Number	:	631-356-4548
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 WALT WHITMAN RD
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-4112
Country	:	US
Telephone Number	:	516-206-6581
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2019
Last Update Date	:	06/05/2025

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