=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629787403
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAZEL JAMIESON LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2022
-----------------------------------------------------
Last Update Date | 11/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 86 WOOLSEY CT
-----------------------------------------------------
City | PENNINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08534-1428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-690-3407
-----------------------------------------------------
Fax | 844-222-5671
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 392
-----------------------------------------------------
City | PENNINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08534-0392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-737-1115
-----------------------------------------------------
Fax | 609-730-9097
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. HAZEL WENDY JAMIESON
-----------------------------------------------------
Credential | LCSW, LCADC, CSS
-----------------------------------------------------
Telephone | 609-690-3407
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------