Healthcare Provider Details

I. General information

NPI: 1447626361
Provider Name (Legal Business Name): JAMIE STURM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LYNCROFT RD
NEW ROCHELLE NY
10804-4103
US

IV. Provider business mailing address

111 LYNCROFT RD
NEW ROCHELLE NY
10804-4103
US

V. Phone/Fax

Practice location:
  • Phone: 617-921-0824
  • Fax:
Mailing address:
  • Phone: 617-921-0824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number090748
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: