Healthcare Provider Details

I. General information

NPI: 1306654264
Provider Name (Legal Business Name): JIMINI HEALTH PSYCHOTHERAPY NJ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2024
Last Update Date: 12/24/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 16TH ST STE 1400
DENVER CO
80202
US

IV. Provider business mailing address

110 16TH ST STE 1400
DENVER CO
80202-5275
US

V. Phone/Fax

Practice location:
  • Phone: 914-357-4009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CHIARA WAINGARTEN
Title or Position: SECRETARY
Credential:
Phone: 786-247-3983