Provider Demographics
NPI:1750916060
Name:HACKETT, JASMINE NICHOLE (LSW)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:NICHOLE
Last Name:HACKETT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 FEATHER DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4285
Mailing Address - Country:US
Mailing Address - Phone:302-252-6908
Mailing Address - Fax:
Practice Address - Street 1:200 S DUPONT ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3972
Practice Address - Country:US
Practice Address - Phone:302-252-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ4-0000059104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty