Provider Demographics
NPI:1437260999
Name:STOCKMAN, JESSICA I (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:I
Last Name:STOCKMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 MAPLE ST STE 201
Mailing Address - Street 2:CENTER FOR HEALTHY AGING
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-4065
Mailing Address - Country:US
Mailing Address - Phone:978-646-7070
Mailing Address - Fax:
Practice Address - Street 1:480 MAPLE ST STE 201
Practice Address - Street 2:CENTER FOR HEALTHY AGING
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-4065
Practice Address - Country:US
Practice Address - Phone:978-646-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10316771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical