Provider Demographics
NPI:1841091576
Name:CLARDY, JASMIN MARIE GOODS (QMHA)
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:MARIE GOODS
Last Name:CLARDY
Suffix:
Gender:
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13402 S CATALINA AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-1923
Mailing Address - Country:US
Mailing Address - Phone:310-906-9282
Mailing Address - Fax:
Practice Address - Street 1:1505 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3916
Practice Address - Country:US
Practice Address - Phone:725-204-9548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker