MEDICARE: MRS. JAIME OSTENDORF MASOTTI

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	101YM0800X	Mental Health Counselor	LH61630483	WA
2	101YM0800X	Mental Health Counselor	1708	FL
3	101YM0800X	Mental Health Counselor	LMHC10001328	MA
4	101YM0800X	Mental Health Counselor	7192	NC

General Provider Information

NPI Number	:	1861010027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAIME OSTENDORF MASOTTI

Provider Business Mailing Address
First Line	:	3058 CYPRESS CREEK DR N
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-3018
Country	:	US
Telephone Number	:	404-769-3229
Fax Number	:

Provider Business Practice Location Address
First Line	:	3058 CYPRESS CREEK DR N
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-3018
Country	:	US
Telephone Number	:	404-769-3229
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	04/17/2026

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