Provider Demographics
NPI:1033584636
Name:DAVIS, JESSICA RENEE (LSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:RENEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 N FRONT ST
Mailing Address - Street 2:APT A SECOND FLOOR
Mailing Address - City:WORMLEYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1112
Mailing Address - Country:US
Mailing Address - Phone:717-385-8675
Mailing Address - Fax:
Practice Address - Street 1:314 N FRONT ST
Practice Address - Street 2:APT A SECOND FLOOR
Practice Address - City:WORMLEYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17043-1112
Practice Address - Country:US
Practice Address - Phone:717-385-8675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW131635104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker