=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770287153
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JSA PSYCHOTHERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2023
-----------------------------------------------------
Last Update Date | 07/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7920 PICKLEWOOD PARK DR
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33437-7524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-363-6359
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6615 W BOYNTON BEACH BLVD STE 424
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33437-3526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-266-4001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JENNIFER ALMINANA
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 561-266-4001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------