Provider Demographics
NPI:1316672322
Name:ANTHONY, JASMINE (LMSW)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 BLADES FARM RD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-3488
Mailing Address - Country:US
Mailing Address - Phone:302-519-3130
Mailing Address - Fax:
Practice Address - Street 1:1140 BLADES FARM RD STE 202
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-3489
Practice Address - Country:US
Practice Address - Phone:410-204-4554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28719207Q00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty