Healthcare Provider Details

I. General information

NPI: 1629787403
Provider Name (Legal Business Name): HAZEL JAMIESON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 11/21/2022
Certification Date: 11/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 WOOLSEY CT
PENNINGTON NJ
08534-1428
US

IV. Provider business mailing address

PO BOX 392
PENNINGTON NJ
08534-0392
US

V. Phone/Fax

Practice location:
  • Phone: 609-690-3407
  • Fax: 844-222-5671
Mailing address:
  • Phone: 609-737-1115
  • Fax: 609-730-9097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. HAZEL WENDY JAMIESON
Title or Position: OWNER
Credential: LCSW, LCADC, CSS
Phone: 609-690-3407