Provider Demographics
NPI:1770722795
Name:MONTRELLA, JESSICA LEIGH (LCSW)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LEIGH
Last Name:MONTRELLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E CALDER WAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4756
Mailing Address - Country:US
Mailing Address - Phone:814-235-5588
Mailing Address - Fax:814-272-0043
Practice Address - Street 1:204 E CALDER WAY
Practice Address - Street 2:205
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4756
Practice Address - Country:US
Practice Address - Phone:814-235-5588
Practice Address - Fax:814-272-0043
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-14
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0162331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical