Provider Demographics
NPI:1194837898
Name:MANNING, JESSICA S (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:S
Last Name:MANNING
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-0671
Mailing Address - Country:US
Mailing Address - Phone:401-935-9041
Mailing Address - Fax:401-683-0753
Practice Address - Street 1:3047 E MAIN RD
Practice Address - Street 2:SUITE 7B
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-4263
Practice Address - Country:US
Practice Address - Phone:401-935-9041
Practice Address - Fax:401-683-0753
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW019021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIJM55185Medicaid
RI0018047Medicare PIN