Healthcare Provider Details

I. General information

NPI: 1588333512
Provider Name (Legal Business Name): JASMINE LUZ BUHTANICVELA MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 BROAD ST
STROUDSBURG PA
18360-1534
US

IV. Provider business mailing address

2119 EDDY LN
EAST STROUDSBURG PA
18301-7731
US

V. Phone/Fax

Practice location:
  • Phone: 973-983-3919
  • Fax:
Mailing address:
  • Phone: 570-688-3284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW141741
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: