Provider Demographics
NPI:1790092716
Name:WOLBER, JESSICA (MSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WOLBER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FORT HILL RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4723
Mailing Address - Country:US
Mailing Address - Phone:860-207-5575
Mailing Address - Fax:860-415-8385
Practice Address - Street 1:10 FORT HILL RD UNIT 1
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4723
Practice Address - Country:US
Practice Address - Phone:860-207-5575
Practice Address - Fax:860-415-8385
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004083309Medicaid