Provider Demographics
NPI:1841776507
Name:DEMEULE, JESSICA LYN (LICSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYN
Last Name:DEMEULE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYN
Other - Last Name:SANDEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:5 KENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NH
Mailing Address - Zip Code:03858-3916
Mailing Address - Country:US
Mailing Address - Phone:716-673-5164
Mailing Address - Fax:
Practice Address - Street 1:6 CONCORDIA DR
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-2062
Practice Address - Country:US
Practice Address - Phone:978-912-9033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1175561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical