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General NPI Number Information
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NPI Number | 1912793324
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Entity Type | Individual
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Provider Name | JASMINE NORTHERN MSW, LBS
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Gender | Female
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 111 ELWYN RD
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City | MEDIA
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State | PA
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Zip | 19063-4622
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Country | US
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Telephone | 610-891-2437
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Fax |
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Provider Business Mailing Address
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Address Line | 8309 WILLIAMS AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19150-2022
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Country | US
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Telephone | 267-474-1996
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Fax | 267-474-1996
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | BH006814
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License Number State | PA
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