Provider Demographics
NPI:1740300144
Name:HESSE, JERALEA F (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:JERALEA
Middle Name:F
Last Name:HESSE
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:HESSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW,LCSW
Mailing Address - Street 1:127 KINGS HIGHWAY NORTH
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880
Mailing Address - Country:US
Mailing Address - Phone:203-227-4201
Mailing Address - Fax:
Practice Address - Street 1:127 KINGS HIGHWAY NORTH
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880
Practice Address - Country:US
Practice Address - Phone:203-227-4201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0005701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000570OtherLCSW