MEDICARE: MARIPOSA HEALING ALLIANCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1417819384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIPOSA HEALING ALLIANCE

Provider Business Mailing Address
First Line	:	540 LIBERTY AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-4022
Country	:	US
Telephone Number	:	201-456-4568
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 CENTRAL AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-2783
Country	:	US
Telephone Number	:	973-520-6831
Fax Number	:	973-520-6831

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. CHARISSA D. PIZARRO
Credential	:	PSYD
Telephone Number	:	201-456-4568

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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Directions to “MARIPOSA HEALING ALLIANCE ” Practice Location

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