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General NPI Number Information
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NPI Number | 1285521468
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Entity Type | Individual
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Provider Name | JASMINE MAGNOLIA
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Gender | Female
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Dates
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Enumeration Date | 06/20/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 136 MADISON AVE 6TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10016
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Country | US
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Telephone | 914-862-8837
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Fax | 914-566-4432
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Provider Business Mailing Address
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Address Line | PO BOX 100031
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City | STATEN ISLAND
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State | NY
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Zip | 10310-0031
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Country | US
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Telephone | 914-862-8837
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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 | 017006
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License Number State | NY
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