Provider Demographics
NPI:1255005484
Name:JASMINE WITKOWSKI, PC
Entity Type:Organization
Organization Name:JASMINE WITKOWSKI, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:N
Authorized Official - Last Name:WITKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:774-766-7986
Mailing Address - Street 1:3 BRIAR PATH WAY
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MA
Mailing Address - Zip Code:02330-1350
Mailing Address - Country:US
Mailing Address - Phone:774-766-7986
Mailing Address - Fax:
Practice Address - Street 1:28 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-4947
Practice Address - Country:US
Practice Address - Phone:774-766-7986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health