Provider Demographics
NPI:1760820427
Name:SANCHEZ, JESSICA LORRAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LORRAINE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 W OLD PAINT TRL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-6608
Mailing Address - Country:US
Mailing Address - Phone:844-385-3747
Mailing Address - Fax:480-462-2801
Practice Address - Street 1:2820 N GLASSFORD HILL RD STE 108
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2256
Practice Address - Country:US
Practice Address - Phone:844-385-3747
Practice Address - Fax:480-462-2801
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA867031041C0700X
CAASW64926104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker