Provider Demographics
NPI:1104069400
Name:ECKERT, JAIME JEANETTE (RN, PMHCNS-BC)
Entity type:Individual
Prefix:MS
First Name:JAIME
Middle Name:JEANETTE
Last Name:ECKERT
Suffix:
Gender:F
Credentials:RN, PMHCNS-BC
Other - Prefix:MS
Other - First Name:JAIME
Other - Middle Name:JEANETTE
Other - Last Name:HORONJEFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN/PC, PMHCNS-BC
Mailing Address - Street 1:170 MORTON ST
Mailing Address - Street 2:MICHAEL J. GILL MENTAL HEALTH & WELLNESS CLINIC
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3735
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN272291364SP0808X
MA272291364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health