Provider Demographics
NPI:1578877247
Name:EPSTEIN-MARES, JORIE ANNE (LICSW, C-SWHC)
Entity Type:Individual
Prefix:MS
First Name:JORIE
Middle Name:ANNE
Last Name:EPSTEIN-MARES
Suffix:
Gender:F
Credentials:LICSW, C-SWHC
Other - Prefix:MS
Other - First Name:JORIE
Other - Middle Name:ANNE
Other - Last Name:EPSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW, C-SWHC
Mailing Address - Street 1:3550 MAIN STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1078
Mailing Address - Country:US
Mailing Address - Phone:413-858-7408
Mailing Address - Fax:413-746-0380
Practice Address - Street 1:3550 MAIN STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1078
Practice Address - Country:US
Practice Address - Phone:413-858-7408
Practice Address - Fax:413-746-0380
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IL149-0152581041C0700X
MA1177181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1101281681AMedicaid