Provider Demographics
NPI:1134648090
Name:HARDMON, JASMINE (RBT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:HARDMON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 GULF BREEZE PKWY
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3350
Mailing Address - Country:US
Mailing Address - Phone:800-676-5130
Mailing Address - Fax:888-958-5753
Practice Address - Street 1:645 BALTIMORE ANNAPOLIS BLVD STE 216-217
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3931
Practice Address - Country:US
Practice Address - Phone:800-676-5130
Practice Address - Fax:888-958-5753
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-17-40438106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician