Provider Demographics
NPI:1841084050
Name:RUSSELL-PETER, JASMINE MERYLN
Entity type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:MERYLN
Last Name:RUSSELL-PETER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 BATTERY LN
Mailing Address - Street 2:
Mailing Address - City:OWINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20736-3142
Mailing Address - Country:US
Mailing Address - Phone:757-515-3250
Mailing Address - Fax:
Practice Address - Street 1:1822 BATTERY LN
Practice Address - Street 2:
Practice Address - City:OWINGS
Practice Address - State:MD
Practice Address - Zip Code:20736-3142
Practice Address - Country:US
Practice Address - Phone:757-515-3250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist