Healthcare Provider Details

I. General information

NPI: 1578942660
Provider Name (Legal Business Name): JAMIE GERMINARIO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE BREITWIESER LCSW

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 S FULLERTON AVE 210
MONTCLAIR NJ
07042-2632
US

IV. Provider business mailing address

17-07 ROMAINE ST
FAIR LAWN NJ
07410-2150
US

V. Phone/Fax

Practice location:
  • Phone: 973-744-6522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05843100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05856900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: