MEDICARE: JSA PSYCHOTHERAPY LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1770287153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JSA PSYCHOTHERAPY LLC

Provider Business Mailing Address
First Line	:	6615 W BOYNTON BEACH BLVD STE 424
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3526
Country	:	US
Telephone Number	:	561-266-4001
Fax Number	:

Provider Business Practice Location Address
First Line	:	7920 PICKLEWOOD PARK DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-7524
Country	:	US
Telephone Number	:	917-363-6359
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER ALMINANA
Credential	:	LCSW
Telephone Number	:	561-266-4001

Provider Enumeration Date	:	03/29/2023
Last Update Date	:	07/11/2023

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