Healthcare Provider Details

I. General information

NPI: 1295597375
Provider Name (Legal Business Name): JASMINE BROWN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 BORDENTOWN AVE
SOUTH AMBOY NJ
08879-1546
US

IV. Provider business mailing address

510 MILLBURN AVE APT 106
SHORT HILLS NJ
07078-2502
US

V. Phone/Fax

Practice location:
  • Phone: 732-313-7378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC01302600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: