Provider Demographics
NPI:1821440843
Name:FLORESTA, JESSICA MARIA (LCSW, CST-S)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIA
Last Name:FLORESTA
Suffix:
Gender:F
Credentials:LCSW, CST-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 MANTUA PIKE STE 701
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-1606
Mailing Address - Country:US
Mailing Address - Phone:609-225-9641
Mailing Address - Fax:609-225-9641
Practice Address - Street 1:101 E MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2920
Practice Address - Country:US
Practice Address - Phone:609-225-9641
Practice Address - Fax:609-225-9641
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0204331041C0700X
NJ44SC058219001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty