Provider Demographics
NPI:1841566536
Name:JESSER, DOROTHEA (LICSW)
Entity Type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:
Last Name:JESSER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:TAFTSVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05073-0096
Mailing Address - Country:US
Mailing Address - Phone:802-345-5637
Mailing Address - Fax:
Practice Address - Street 1:41 WHITCOMB LANE
Practice Address - Street 2:
Practice Address - City:TAFTSVILLE
Practice Address - State:VT
Practice Address - Zip Code:05073
Practice Address - Country:US
Practice Address - Phone:802-345-5637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00770191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical