Provider Demographics
NPI:1063599611
Name:JASMIN, HURGUENS A (LCSW)
Entity type:Individual
Prefix:
First Name:HURGUENS
Middle Name:A
Last Name:JASMIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 E 105TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4663
Mailing Address - Country:US
Mailing Address - Phone:347-713-8766
Mailing Address - Fax:
Practice Address - Street 1:269 S KING ST
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4234
Practice Address - Country:US
Practice Address - Phone:516-983-5367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071119-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4740DKMedicare ID - Type UnspecifiedMEDICARE NUMBER