Provider Demographics
NPI:1568139939
Name:MIN, JAMIE JY (LSW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:JY
Last Name:MIN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:JIMIN
Other - Middle Name:
Other - Last Name:YOUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:318 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08850-1440
Mailing Address - Country:US
Mailing Address - Phone:201-790-8020
Mailing Address - Fax:
Practice Address - Street 1:39 N CLINTON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08609-1011
Practice Address - Country:US
Practice Address - Phone:609-394-9398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06362800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker