Provider Demographics
NPI:1629349600
Name:MARTIN, JESSICA ALYSSA
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ALYSSA
Last Name:MARTIN
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 1:260 WATKINS ST
Mailing Address - Street 2:
Mailing Address - City:SWOYERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-2139
Mailing Address - Country:US
Mailing Address - Phone:570-899-8278
Mailing Address - Fax:
Practice Address - Street 1:1172 TWIN STACKS DR # 427
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-8505
Practice Address - Country:US
Practice Address - Phone:570-674-1505
Practice Address - Fax:570-674-8679
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health