Provider Demographics
NPI:1629091715
Name:WRIGHT, JESSICA K (LCMHC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:K
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3488 THAYER BROOK RD
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:VT
Mailing Address - Zip Code:05060-9201
Mailing Address - Country:US
Mailing Address - Phone:802-505-8596
Mailing Address - Fax:
Practice Address - Street 1:28 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1265
Practice Address - Country:US
Practice Address - Phone:802-505-8596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000468101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007326Medicaid
VT14Y000794VT01OtherBC/BS OF NH
VT00048725OtherBC/BS OF VT
VT989026COtherMVP HEALTHCARE
VT373342OtherTRICARE
VT2052859OtherCIGNA