Provider Demographics
NPI:1528178167
Name:JASPER, NANCY L (LICSW)
Entity type:Individual
Prefix:MISS
First Name:NANCY
Middle Name:L
Last Name:JASPER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 ANGELL ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4016
Mailing Address - Country:US
Mailing Address - Phone:401-274-6072
Mailing Address - Fax:
Practice Address - Street 1:19 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-6306
Practice Address - Country:US
Practice Address - Phone:401-841-8896
Practice Address - Fax:401-848-4191
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW008311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1021100OtherNHP - GROUP NUMBER
RI331435OtherTRI-CARE
RI406489OtherBLUE CHIP
RI62-52964OtherUNITED BEHAVIORAL HEALTH
RI30634-6OtherBLUE CROSS/ BLUE SHIELD
RI311822OtherMAGELLAN- GROUP NUMBER
RINJ03896Medicaid