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General NPI Number Information
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NPI Number | 1417819384
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Entity Type | Organization
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Legal Business Name | MARIPOSA HEALING ALLIANCE
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 430 CENTRAL AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07307-2783
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Country | US
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Telephone | 973-520-6831
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Fax | 973-520-6831
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Provider Business Mailing Address
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Address Line | 540 LIBERTY AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07307-4022
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Country | US
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Telephone | 201-456-4568
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. CHARISSA D. PIZARRO
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Credential | PSYD
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Telephone | 201-456-4568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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