Provider Demographics
NPI:1154069953
Name:MANN, JESSICA (LCSW LCADC CCTP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:LCSW LCADC CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S RALEIGH AVE APT 8A
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-5845
Mailing Address - Country:US
Mailing Address - Phone:609-705-1183
Mailing Address - Fax:
Practice Address - Street 1:600 S ODESSA AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08215-3524
Practice Address - Country:US
Practice Address - Phone:609-594-2430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060248001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical