Healthcare Provider Details

I. General information

NPI: 1750238366
Provider Name (Legal Business Name): JASMINE BRISCOE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 FRASER RD
BRYANS ROAD MD
20616-3026
US

IV. Provider business mailing address

3001 FRASER RD
BRYANS ROAD MD
20616-3026
US

V. Phone/Fax

Practice location:
  • Phone: 240-903-5667
  • Fax:
Mailing address:
  • Phone: 240-903-5667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21217
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: