Provider Demographics
NPI:1588333512
Name:BUHTANICVELA, JASMINE LUZ (MSW, LSW)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:LUZ
Last Name:BUHTANICVELA
Suffix:
Gender:
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 EDDY LN
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-7731
Mailing Address - Country:US
Mailing Address - Phone:570-688-3284
Mailing Address - Fax:
Practice Address - Street 1:117 BROAD ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1534
Practice Address - Country:US
Practice Address - Phone:973-983-3919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW141741104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker