Provider Demographics
NPI:1619673712
Name:JESSIE, BARONNIE JEREMIAH (MSW)
Entity Type:Individual
Prefix:
First Name:BARONNIE
Middle Name:JEREMIAH
Last Name:JESSIE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:JESSIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:4620 W OLNEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2083
Mailing Address - Country:US
Mailing Address - Phone:626-404-8097
Mailing Address - Fax:
Practice Address - Street 1:1500 E THOMAS RD STE 106
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5748
Practice Address - Country:US
Practice Address - Phone:602-248-6040
Practice Address - Fax:602-279-8957
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker