Provider Demographics
NPI:1184627184
Name:REED, JESSICA A (LICSW)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:A
Last Name:REED
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 1:8 OLD GREENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-4424
Mailing Address - Country:US
Mailing Address - Phone:508-930-2342
Mailing Address - Fax:781-449-6210
Practice Address - Street 1:8 OLD GREENDALE AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-4424
Practice Address - Country:US
Practice Address - Phone:508-930-2342
Practice Address - Fax:781-449-6210
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
MA10209651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07529OtherBLUE CROSS BLUE SHIELD
MARE P21180Medicare ID - Type Unspecified