Provider Demographics
NPI:1720788789
Name:THOMAS, JASMINE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:THOMAS
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 1:1818 NEW YORK AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1848
Mailing Address - Country:US
Mailing Address - Phone:202-269-2401
Mailing Address - Fax:
Practice Address - Street 1:1818 NEW YORK AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1848
Practice Address - Country:US
Practice Address - Phone:202-269-2401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-08-21
Deactivation Date:2023-03-09
Deactivation Code:
Reactivation Date:2023-05-25
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 171M00000X
DC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician