Basic Information
| Provider Information | |||||||||
| NPI: | 1528178167 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JASPER | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 395 ANGELL ST | ||||||||
| Address2: | UNIT 1 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029064016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012746072 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19 VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028426306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018418896 | ||||||||
| FaxNumber: | 4018484191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 1041C0700X | ISW00831 | RI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1021100 | 01 | RI | NHP - GROUP NUMBER | OTHER | 331435 | 01 | RI | TRI-CARE | OTHER | 406489 | 01 | RI | BLUE CHIP | OTHER | 62-52964 | 01 | RI | UNITED BEHAVIORAL HEALTH | OTHER | 30634-6 | 01 | RI | BLUE CROSS/ BLUE SHIELD | OTHER | 311822 | 01 | RI | MAGELLAN- GROUP NUMBER | OTHER | NJ03896 | 05 | RI | MEDICAID |