Healthcare Provider Details

I. General information

NPI: 1396513743
Provider Name (Legal Business Name): JIMENA G LOZOVIKAS GARABEDIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MAIN ST S STE 201
SOUTHBURY CT
06488-2224
US

IV. Provider business mailing address

8 APPLE DR
OXFORD CT
06478-3203
US

V. Phone/Fax

Practice location:
  • Phone: 203-255-5078
  • Fax:
Mailing address:
  • Phone: 203-240-0137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6598
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: