Provider Demographics
NPI:1568894012
Name:WHITTEMORE, JESSICA K (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:K
Last Name:WHITTEMORE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N CHARLES ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5920
Mailing Address - Country:US
Mailing Address - Phone:410-234-2727
Mailing Address - Fax:410-234-2777
Practice Address - Street 1:1800 N CHARLES ST
Practice Address - Street 2:SUITE 208
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5920
Practice Address - Country:US
Practice Address - Phone:410-234-2727
Practice Address - Fax:410-234-2777
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15036104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
15036OtherLCSW-C