Provider Demographics
NPI:1972143915
Name:ELIASSAINT, JASON GADNER (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:GADNER
Last Name:ELIASSAINT
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 LYONS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3407
Mailing Address - Country:US
Mailing Address - Phone:404-992-1632
Mailing Address - Fax:
Practice Address - Street 1:10301 GEORGIA AVE STE 203W
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5020
Practice Address - Country:US
Practice Address - Phone:240-865-3135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR189215363L00000X
261QM0850X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health