Provider Demographics
NPI:1780951467
Name:IVES, JESSICA L (LCPC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:IVES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2362
Mailing Address - Country:US
Mailing Address - Phone:443-477-3589
Mailing Address - Fax:410-228-0513
Practice Address - Street 1:3 CEDAR ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2362
Practice Address - Country:US
Practice Address - Phone:443-477-3589
Practice Address - Fax:410-228-0513
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2578101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional