Provider Demographics
NPI:1093440729
Name:JAMISON, CHANA IMANI (BM, MT-BC)
Entity type:Individual
Prefix:MS
First Name:CHANA
Middle Name:IMANI
Last Name:JAMISON
Suffix:
Gender:F
Credentials:BM, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 SHEPHARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-3307
Mailing Address - Country:US
Mailing Address - Phone:917-569-2836
Mailing Address - Fax:
Practice Address - Street 1:119 SHEPHARD AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-3307
Practice Address - Country:US
Practice Address - Phone:917-569-2836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15112225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist