Provider Demographics
NPI:1417465725
Name:REYNOLDS, JESSICA CARON (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:CARON
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:CARON
Other - Last Name:DANFORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:WEST WARREN
Mailing Address - State:MA
Mailing Address - Zip Code:01092-0234
Mailing Address - Country:US
Mailing Address - Phone:413-351-1267
Mailing Address - Fax:
Practice Address - Street 1:96 SOUTH ST
Practice Address - Street 2:
Practice Address - City:WARE
Practice Address - State:MA
Practice Address - Zip Code:01082-1616
Practice Address - Country:US
Practice Address - Phone:413-967-6241
Practice Address - Fax:413-967-9807
Is Sole Proprietor?:No
Enumeration Date:2018-01-21
Last Update Date:2018-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1166821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical