Healthcare Provider Details

I. General information

NPI: 1417819384
Provider Name (Legal Business Name): MARIPOSA HEALING ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 CENTRAL AVE
JERSEY CITY NJ
07307-2783
US

IV. Provider business mailing address

540 LIBERTY AVE
JERSEY CITY NJ
07307-4022
US

V. Phone/Fax

Practice location:
  • Phone: 973-520-6831
  • Fax: 973-520-6831
Mailing address:
  • Phone: 201-456-4568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARISSA D. PIZARRO
Title or Position: EXECUTIVE DIRECTOR
Credential: PSYD
Phone: 201-456-4568