Provider Demographics
NPI:1740657766
Name:MCDAID, JESSIE DANIELLE
Entity type:Individual
Prefix:MISS
First Name:JESSIE
Middle Name:DANIELLE
Last Name:MCDAID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-4804
Mailing Address - Country:US
Mailing Address - Phone:781-929-1355
Mailing Address - Fax:
Practice Address - Street 1:168 LEWIS ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-4804
Practice Address - Country:US
Practice Address - Phone:781-929-1355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health