Provider Demographics
NPI:1235283334
Name:PEIRCE, JESSICA MARJORIE (PHD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARJORIE
Last Name:PEIRCE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6532 SEAPEARL LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4652
Mailing Address - Country:US
Mailing Address - Phone:410-550-5828
Mailing Address - Fax:410-550-0060
Practice Address - Street 1:5200 EASTERN AVE
Practice Address - Street 2:MASON F. LORD, 6TH FLOOR EAST
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2734
Practice Address - Country:US
Practice Address - Phone:410-550-5828
Practice Address - Fax:410-550-0060
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03939103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical