Provider Demographics
NPI:1417663840
Name:TINEO, JASMARY M
Entity Type:Individual
Prefix:
First Name:JASMARY
Middle Name:M
Last Name:TINEO
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 1:205 E BROADWAY STE G
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-2809
Mailing Address - Country:US
Mailing Address - Phone:804-629-2673
Mailing Address - Fax:
Practice Address - Street 1:205 E BROADWAY STE G
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2809
Practice Address - Country:US
Practice Address - Phone:804-629-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health