Provider Demographics
NPI:1750103800
Name:JASMINA MIMICA MENTAL HEALTH COUNSELING PLLC
Entity type:Organization
Organization Name:JASMINA MIMICA MENTAL HEALTH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIMICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-941-2644
Mailing Address - Street 1:123 MELROSE ST APT 820
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-7885
Mailing Address - Country:US
Mailing Address - Phone:646-655-9172
Mailing Address - Fax:
Practice Address - Street 1:138 W 25TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7405
Practice Address - Country:US
Practice Address - Phone:646-655-9172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty