Provider Demographics
NPI:1922349810
Name:MANTASHIAN, JASMEN (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:JASMEN
Middle Name:
Last Name:MANTASHIAN
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 681
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-0681
Mailing Address - Country:US
Mailing Address - Phone:201-390-3074
Mailing Address - Fax:201-891-4671
Practice Address - Street 1:93 FRANKLIN TPKE STE 203
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1859
Practice Address - Country:US
Practice Address - Phone:201-390-3074
Practice Address - Fax:201-891-4671
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-03
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054685001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical