Provider Demographics
NPI:1689247116
Name:JASPER-VERA, KATHERINE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:JASPER-VERA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 RENEE LN
Mailing Address - Street 2:
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2142
Mailing Address - Country:US
Mailing Address - Phone:917-213-6812
Mailing Address - Fax:
Practice Address - Street 1:104 RENEE LN
Practice Address - Street 2:
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-2142
Practice Address - Country:US
Practice Address - Phone:917-213-6812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063273104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty