Healthcare Provider Details

I. General information

NPI: 1225600901
Provider Name (Legal Business Name): ANDREA JOY CIMINO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 LINDA AVE
HAWTHORNE NY
10532-2018
US

IV. Provider business mailing address

1 KENNEDY AVE UNIT 2404
DANBURY CT
06810-5986
US

V. Phone/Fax

Practice location:
  • Phone: 914-773-7432
  • Fax:
Mailing address:
  • Phone: 914-826-4629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number098317
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number114829
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: