Provider Demographics
NPI:1780468447
Name:MERRIAM, JESSICA JEAN (MS ED)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JEAN
Last Name:MERRIAM
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 MILL ST STE B
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-3191
Mailing Address - Country:US
Mailing Address - Phone:508-752-8466
Mailing Address - Fax:774-243-6611
Practice Address - Street 1:239 MILL ST STE B
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-3191
Practice Address - Country:US
Practice Address - Phone:508-752-8466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency