Provider Demographics
NPI:1740891142
Name:MACREADY, JESSICA K (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:K
Last Name:MACREADY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:K
Other - Last Name:MACREADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1631 MENDOTA CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2246
Mailing Address - Country:US
Mailing Address - Phone:925-899-0552
Mailing Address - Fax:
Practice Address - Street 1:1 SANTA BARBARA RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4215
Practice Address - Country:US
Practice Address - Phone:925-256-0791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251300000X
CA656661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251300000XAgenciesLocal Education Agency (LEA)