=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588333512
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASMINE LUZ BUHTANICVELA MSW, LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2021
-----------------------------------------------------
Last Update Date | 03/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 BROAD ST
-----------------------------------------------------
City | STROUDSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18360-1534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-983-3919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2119 EDDY LN
-----------------------------------------------------
City | EAST STROUDSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18301-7731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-688-3284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | SW141741
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------