Provider Demographics
NPI:1144399254
Name:BIRCKHEAD, JESSIE LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:LYNN
Last Name:BIRCKHEAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:LYNN
Other - Last Name:LEUW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2045 WESTGATE DRIVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017
Mailing Address - Country:US
Mailing Address - Phone:610-882-2055
Mailing Address - Fax:610-882-3633
Practice Address - Street 1:2045 WESTGATE DRIVE
Practice Address - Street 2:SUITE 402
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017
Practice Address - Country:US
Practice Address - Phone:610-882-2055
Practice Address - Fax:610-882-3633
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0135791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical