Provider Demographics
NPI:1518113372
Name:TIMMONS, JESSIE M (MSW, LSW)
Entity Type:Individual
Prefix:MS
First Name:JESSIE
Middle Name:M
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 S 16TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2100
Mailing Address - Country:US
Mailing Address - Phone:610-256-8885
Mailing Address - Fax:
Practice Address - Street 1:1200 CHESTNUT ST FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4805
Practice Address - Country:US
Practice Address - Phone:215-563-0663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126824101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health