Provider Demographics
NPI:1275934655
Name:COLLINS, JESSICA DANIELLE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DANIELLE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 MANUEL ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15214-2121
Mailing Address - Country:US
Mailing Address - Phone:412-606-4385
Mailing Address - Fax:
Practice Address - Street 1:5167 BUTLER ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15201-2606
Practice Address - Country:US
Practice Address - Phone:412-781-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130440104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker