Provider Demographics
NPI:1982205910
Name:PUGA, JESSICA (MSW, PLMHP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PUGA
Suffix:
Gender:F
Credentials:MSW, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 N 90TH ST APT 310
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2856
Mailing Address - Country:US
Mailing Address - Phone:308-216-2104
Mailing Address - Fax:
Practice Address - Street 1:5625 N 28TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-1765
Practice Address - Country:US
Practice Address - Phone:531-299-1827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11945104100000X, 1041C0700X
NE119451041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical