Provider Demographics
NPI:1518344399
Name:ALSIS, JESSICA T (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:T
Last Name:ALSIS
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 1:47 N NEW ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3019
Mailing Address - Country:US
Mailing Address - Phone:484-450-6476
Mailing Address - Fax:610-544-7142
Practice Address - Street 1:390 REED RD FL 1
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-4008
Practice Address - Country:US
Practice Address - Phone:484-450-6476
Practice Address - Fax:484-224-3398
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 104100000X
PACW0000001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker