Provider Demographics
NPI:1336383108
Name:MCCURDY, JESSICA BENTON (MA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:BENTON
Last Name:MCCURDY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ARROWHEAD RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6522
Mailing Address - Country:US
Mailing Address - Phone:207-837-9997
Mailing Address - Fax:
Practice Address - Street 1:6 ARROWHEAD RIDGE RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6522
Practice Address - Country:US
Practice Address - Phone:207-837-9997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME407375222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist