Basic Information
| Provider Information | |||||||||
| NPI: | 1053507079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SINNOTT | ||||||||
| FirstName: | JAMIE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18302 IRVINE BLVD | ||||||||
| Address2: | #300 | ||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927803435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149571004 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 18302 IRVINE BLVD | ||||||||
| Address2: | #300 | ||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927803435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149571004 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2007 | ||||||||
| LastUpdateDate: | 12/19/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 27782 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 27782 | CA | N | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.