Provider Demographics
NPI:1790565752
Name:COSGROVE, JESSICA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45TH MEDICAL GROUP
Mailing Address - Street 2:1381 SOUTH PATRICK DR
Mailing Address - City:PATRICK SFB
Mailing Address - State:FL
Mailing Address - Zip Code:32925
Mailing Address - Country:US
Mailing Address - Phone:321-494-8234
Mailing Address - Fax:
Practice Address - Street 1:45TH MEDICAL GROUP
Practice Address - Street 2:1381 SOUTH PATRICK DR
Practice Address - City:PATRICK SFB
Practice Address - State:FL
Practice Address - Zip Code:32925
Practice Address - Country:US
Practice Address - Phone:321-494-8234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist