Provider Demographics
NPI:1477734069
Name:EDWARDS, JESSICA (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 APPLETON ST
Mailing Address - Street 2:LOWELL JUVENILE COURT CLINIC
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-2505
Mailing Address - Country:US
Mailing Address - Phone:978-447-2731
Mailing Address - Fax:978-275-0728
Practice Address - Street 1:89 APPLETON ST
Practice Address - Street 2:LOWELL JUVENILE COURT CLINIC
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2505
Practice Address - Country:US
Practice Address - Phone:978-447-2731
Practice Address - Fax:978-275-0728
Is Sole Proprietor?:No
Enumeration Date:2007-11-25
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1146391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical