Provider Demographics
NPI:1275872541
Name:ANDRADE, JESSICA R (LGSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:R
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20245 SHIPLEY TER APT 101
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-3714
Mailing Address - Country:US
Mailing Address - Phone:240-505-1086
Mailing Address - Fax:
Practice Address - Street 1:20245 SHIPLEY TER APT 101
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-3714
Practice Address - Country:US
Practice Address - Phone:240-505-1086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17675104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker