Provider Demographics
NPI:1841863222
Name:BOROSKI, JAIME LYNN (CDCA)
Entity type:Individual
Prefix:MS
First Name:JAIME
Middle Name:LYNN
Last Name:BOROSKI
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1479 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BRILLIANT
Mailing Address - State:OH
Mailing Address - Zip Code:43913-1000
Mailing Address - Country:US
Mailing Address - Phone:740-598-2054
Mailing Address - Fax:
Practice Address - Street 1:1479 3RD ST
Practice Address - Street 2:
Practice Address - City:BRILLIANT
Practice Address - State:OH
Practice Address - Zip Code:43913-1000
Practice Address - Country:US
Practice Address - Phone:740-598-2054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH176963101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)