Provider Demographics
NPI:1679247878
Name:KOONTZ-FERRERA, JESSICA M (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:KOONTZ-FERRERA
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:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21150-0307
Mailing Address - Country:US
Mailing Address - Phone:443-545-9027
Mailing Address - Fax:
Practice Address - Street 1:49 ROCK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CONOWINGO
Practice Address - State:MD
Practice Address - Zip Code:21918-1352
Practice Address - Country:US
Practice Address - Phone:410-378-9696
Practice Address - Fax:410-378-9922
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD233151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical