Provider Demographics
NPI:1336209543
Name:FLINT, JESSICA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:M
Last Name:FLINT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4475 ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08528-9601
Mailing Address - Country:US
Mailing Address - Phone:917-476-1970
Mailing Address - Fax:
Practice Address - Street 1:4475 ROUTE 27
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:08528-9601
Practice Address - Country:US
Practice Address - Phone:917-476-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054315001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC05431500OtherLCSW LICENSE NUMBER