Provider Demographics
NPI:1245598564
Name:LOWE, JESSE ISAAK ROSS (MA)
Entity Type:Individual
Prefix:MRS
First Name:JESSE
Middle Name:ISAAK ROSS
Last Name:LOWE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:JESSE
Other - Middle Name:
Other - Last Name:ISAAK-ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:126 PHOENIX AVE
Mailing Address - Street 2:BLD #2
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-4931
Mailing Address - Country:US
Mailing Address - Phone:978-453-8331
Mailing Address - Fax:
Practice Address - Street 1:126 PHOENIX AVE
Practice Address - Street 2:BLD #2
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-4931
Practice Address - Country:US
Practice Address - Phone:978-453-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist