Healthcare Provider Details

I. General information

NPI: 1053507079
Provider Name (Legal Business Name): JAMIE SINNOTT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 12/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18302 IRVINE BLVD #300
TUSTIN CA
92780-3435
US

IV. Provider business mailing address

18302 IRVINE BLVD #300
TUSTIN CA
92780-3435
US

V. Phone/Fax

Practice location:
  • Phone: 714-957-1004
  • Fax:
Mailing address:
  • Phone: 714-957-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27782
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number27782
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: