Provider Demographics
NPI:1972934792
Name:JESSIE, SHARON LYNN (LSW)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:LYNN
Last Name:JESSIE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 ROUTE 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-4811
Mailing Address - Country:US
Mailing Address - Phone:732-240-2449
Mailing Address - Fax:732-288-7055
Practice Address - Street 1:1228 ROUTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-4811
Practice Address - Country:US
Practice Address - Phone:732-240-2449
Practice Address - Fax:732-288-7055
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05492100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker