Provider Demographics
NPI:1174338388
Name:JARDINE, JELIEA MAIA (LMSW)
Entity type:Individual
Prefix:
First Name:JELIEA
Middle Name:MAIA
Last Name:JARDINE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 EVERGREEN MEMORIAL PKWY APT 6201
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-1676
Mailing Address - Country:US
Mailing Address - Phone:929-350-7653
Mailing Address - Fax:
Practice Address - Street 1:2201 EVERGREEN MEMORIAL PKWY APT 6201
Practice Address - Street 2:
Practice Address - City:KEMAH
Practice Address - State:TX
Practice Address - Zip Code:77565-1676
Practice Address - Country:US
Practice Address - Phone:929-350-7653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12599501104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker