Provider Demographics
NPI:1508494717
Name:QUINTERO JOHNSON, JESSIE M (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:M
Last Name:QUINTERO JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 PURINTON ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-4604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LIKEMIND MENTAL HEALTH & WELLNESS, INC
Practice Address - Street 2:51 UNION STREET, SUITE 222
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1134
Practice Address - Country:US
Practice Address - Phone:217-649-9280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2232891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical