Provider Demographics
NPI:1396513743
Name:LOZOVIKAS GARABEDIAN, JIMENA G
Entity type:Individual
Prefix:
First Name:JIMENA
Middle Name:G
Last Name:LOZOVIKAS GARABEDIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 APPLE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-3203
Mailing Address - Country:US
Mailing Address - Phone:203-240-0137
Mailing Address - Fax:
Practice Address - Street 1:900 MAIN ST S STE 201
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2224
Practice Address - Country:US
Practice Address - Phone:203-255-5078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT65981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical