Provider Demographics
NPI:1780570374
Name:PETERS, JESSICA MARIE (MSW, LSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:PETERS
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CLOUDCREST DR
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-7723
Mailing Address - Country:US
Mailing Address - Phone:570-390-0137
Mailing Address - Fax:
Practice Address - Street 1:616 MAIN ST STE 400
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1871
Practice Address - Country:US
Practice Address - Phone:570-504-2697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW142255104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker