Provider Demographics
NPI:1649936659
Name:ALONSO, JESSICA BARBARA (LCSW)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:BARBARA
Last Name:ALONSO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:BARBARA
Other - Last Name:ALONSO-KOVACS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW CCM
Mailing Address - Street 1:55 MERRICK WAY APT 623
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5131
Mailing Address - Country:US
Mailing Address - Phone:305-815-2202
Mailing Address - Fax:
Practice Address - Street 1:55 MERRICK WAY APT 623
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5131
Practice Address - Country:US
Practice Address - Phone:305-815-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-14
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW143201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical