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NPI Code Detail

MEDICARE: JASMINE MICHELLE RANDOLPH LGSW

MEDICARE: JASMINE MICHELLE RANDOLPH LGSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerLG50083273DC

General Provider Information

NPI Number : 1396415204
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASMINE MICHELLE RANDOLPH LGSW
Provider Business Mailing Address
First Line : 1801 MISSISSIPPI AVE SE FL 3
Second Line :
City : WASHINGTON
State : DC
Zip : 20020-6124
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1801 MISSISSIPPI AVE SE
Second Line :
City : WASHINGTON
State : DC
Zip : 20020-6120
Country : US
Telephone Number : 240-486-9643
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2021
Last Update Date : 09/14/2021

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Directions to “ JASMINE MICHELLE RANDOLPH LGSW” Practice Location

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