Provider Demographics
NPI:1437559481
Name:HALL, JAZAR (BSC)
Entity Type:Individual
Prefix:
First Name:JAZAR
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6532 N MASCHER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-1040
Mailing Address - Country:US
Mailing Address - Phone:267-401-3102
Mailing Address - Fax:
Practice Address - Street 1:6532 N MASCHER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-1040
Practice Address - Country:US
Practice Address - Phone:267-401-3102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001256101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health