Provider Demographics
NPI:1912793324
Name:NORTHERN, JASMINE (MSW, LBS)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:NORTHERN
Suffix:
Gender:
Credentials:MSW, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8309 WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-2022
Mailing Address - Country:US
Mailing Address - Phone:267-474-1996
Mailing Address - Fax:267-474-1996
Practice Address - Street 1:111 ELWYN RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-4622
Practice Address - Country:US
Practice Address - Phone:610-891-2437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH006814174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist