Provider Demographics
NPI:1972183291
Name:EATON, JESSICA LYNNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNNE
Last Name:EATON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:LYNNE
Other - Last Name:MOWREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:56 EAST BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078
Mailing Address - Country:US
Mailing Address - Phone:518-775-5740
Mailing Address - Fax:518-725-9216
Practice Address - Street 1:56 EAST BOULEVARD
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078
Practice Address - Country:US
Practice Address - Phone:518-775-5740
Practice Address - Fax:518-725-9216
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0900071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical