MEDICARE: JASMINE S IVERSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C015674	NC

General Provider Information

NPI Number	:	1407433840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE S IVERSON LCSW

Provider Business Mailing Address
First Line	:	708 NEWFOUND HOLLOW DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-4502
Country	:	US
Telephone Number	:	336-317-3529
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 S MCDOWELL ST STE 125-1325
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2623
Country	:	US
Telephone Number	:	336-317-3529
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2021
Last Update Date	:	03/12/2023

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