Provider Demographics
NPI:1497929632
Name:NARGISO, JESSICA ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ELLEN
Last Name:NARGISO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 MERRIMAC ST, 6TH FLOOR SUITE
Mailing Address - Street 2:ARMS PROGRAM
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-6220
Mailing Address - Country:US
Mailing Address - Phone:617-726-6453
Mailing Address - Fax:
Practice Address - Street 1:151 MERRIMAC ST, 6TH FLOOR SUITE
Practice Address - Street 2:ARMS PROGRAM
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-6220
Practice Address - Country:US
Practice Address - Phone:617-726-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9565103T00000X
RIPS01239103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPENDINGMedicaid