Provider Demographics
NPI:1750659850
Name:PERKINS, JESSICA L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:PERKINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:HEBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:483 W MIDDLE TPKE
Mailing Address - Street 2:SUITE 217
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-3863
Mailing Address - Country:US
Mailing Address - Phone:860-647-0899
Mailing Address - Fax:
Practice Address - Street 1:40 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2018
Practice Address - Country:US
Practice Address - Phone:860-450-7074
Practice Address - Fax:860-450-0763
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0060831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical