Provider Demographics
NPI:1518567759
Name:RICE, JESSICA LAUREN MCCARTHY
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREN MCCARTHY
Last Name:RICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 COMMUNITY RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4207
Mailing Address - Country:US
Mailing Address - Phone:410-487-4406
Mailing Address - Fax:
Practice Address - Street 1:517 BENFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2527
Practice Address - Country:US
Practice Address - Phone:410-216-4421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23923101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health