Provider Demographics
NPI:1891841755
Name:PEIPOCK, JESSICA L (LICSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:PEIPOCK
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 1:17 ASHTON PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-4827
Mailing Address - Country:US
Mailing Address - Phone:401-632-3040
Mailing Address - Fax:401-721-5610
Practice Address - Street 1:17 ASHTON PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-4827
Practice Address - Country:US
Practice Address - Phone:401-632-3040
Practice Address - Fax:401-721-5610
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW019721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical