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General NPI Number Information
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NPI Number | 1184926339
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Entity Type | Individual
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Provider Name | JASMINE D CLARE PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 11/20/2010
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 460 BLOOMFIELD AVE 4TH FLOOR STE 400
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3582
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Country | US
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Telephone | 603-306-6290
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Fax |
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Provider Business Mailing Address
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Address Line | 460 BLOOMFIELD AVE 4TH FLOOR STE 400
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3582
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Country | US
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Telephone | 603-306-6290
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35S100568000
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 021222
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.008836
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License Number State | IL
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