Provider Demographics
NPI:1073336962
Name:MOTON, JASMINE R
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:R
Last Name:MOTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 CHAPMAN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2198
Mailing Address - Country:US
Mailing Address - Phone:860-538-8513
Mailing Address - Fax:
Practice Address - Street 1:337 CHAPMAN ST APT 3
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2198
Practice Address - Country:US
Practice Address - Phone:860-538-8513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician