Provider Demographics
NPI:1518505973
Name:WEISSMAN, JESSICA LYNN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:WEISSMAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:WEISSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PENNY
Mailing Address - Street 1:188 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:ROCHDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01542-1107
Mailing Address - Country:US
Mailing Address - Phone:774-386-6126
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:774-386-6126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2019044828363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health