Provider Demographics
NPI:1649344540
Name:ROY, JESSICA (LICSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ROY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:HAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:45 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-3469
Mailing Address - Country:US
Mailing Address - Phone:413-568-9858
Mailing Address - Fax:413-568-6492
Practice Address - Street 1:45 BROAD ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-3469
Practice Address - Country:US
Practice Address - Phone:413-568-9858
Practice Address - Fax:413-568-6492
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2015-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1191021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical