Provider Demographics
NPI:1336560135
Name:TEAGUE, JASMINE (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SPRUCE ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-3957
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 SPRUCE ST
Practice Address - Street 2:SUITE 205
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-3957
Practice Address - Country:US
Practice Address - Phone:609-396-6788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06016200104100000X
MD19169104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker