Provider Demographics
NPI:1467963983
Name:WEST, JESSIE STEVENS (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:STEVENS
Last Name:WEST
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:ERIN
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 TALBOT ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3525
Mailing Address - Country:US
Mailing Address - Phone:410-822-1018
Mailing Address - Fax:410-820-5884
Practice Address - Street 1:300 TALBOT ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3525
Practice Address - Country:US
Practice Address - Phone:410-822-1018
Practice Address - Fax:410-820-5884
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD166621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical