Jasmine Mallard

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-21-52124 Issued in NU

Practice address

700 Abbott Dr Ste 2
Broomall, PA 19008-4323

Phone

(484) 995-6547

NPI assigned

Mar 5, 2019

Last updated

Aug 16, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629072000000",
    "number": "1699233908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 N JACKSON ST STE 203",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190632574",
            "telephone_number": "484-444-2285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 ABBOTT DR STE 2",
            "city": "BROOMALL",
            "state": "PA",
            "postal_code": "190084323",
            "telephone_number": "484-995-6547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLARD",
        "first_name": "JASMINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-05",
        "last_updated": "2021-08-16",
        "certification_date": "2021-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": "1-21-52124",
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BACB REGISTRATION NUMBER",
            "identifier": "RBT-18-74281",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Maguire
• Main Line Hospitals, Inc.
• Main Line Hospitals, Inc.
• Main Line PA Endoscopy ASC, LP (Main Line Endoscopy Center Broomall)
• Mainline Healthcare Bryn Mawr Family Practice
• Britnee Driscoll Mallory, LPC
• Christina M Malseed
• Adrianna Mancini
• Justin M Mancini, PHARMD
• Joanne Mandell, APRN, PMHNP-BC

• Behavior Analyst in Broomall, PA
• Providers in Broomall, PA by specialty
• Behavior Analyst in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.