Provider Demographics
NPI:1194342717
Name:GINISI, JILL (PMHNP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:GINISI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 WELLESLEY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1571
Mailing Address - Country:US
Mailing Address - Phone:508-284-2434
Mailing Address - Fax:
Practice Address - Street 1:235 WELLESLEY ST STE 1
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1571
Practice Address - Country:US
Practice Address - Phone:508-284-2434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2289252163W00000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse