Provider Demographics
NPI:1013017698
Name:JASSO, JOSE R JR (MSW)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:R
Last Name:JASSO
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:22405-6111
Mailing Address - Country:US
Mailing Address - Phone:540-834-3567
Mailing Address - Fax:
Practice Address - Street 1:224 WEST D.L. INGRAM AVE.
Practice Address - Street 2:BLDG. 1408
Practice Address - City:CANNON AFB
Practice Address - State:NM
Practice Address - Zip Code:88103-5014
Practice Address - Country:US
Practice Address - Phone:575-784-1108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001494821041C0700X
TX525331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical