Basic Information
| Provider Information | |||||||||
| NPI: | 1003358086 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAIDOO | ||||||||
| FirstName: | JASMIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 HAMILTON ST | ||||||||
| Address2: | |||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128664226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188865601 | ||||||||
| FaxNumber: | 5188865805 | ||||||||
| Practice Location | |||||||||
| Address1: | 58 ACADEMY RD | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184262801 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2016 | ||||||||
| LastUpdateDate: | 09/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 095184 | NY | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 087472 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.