Provider Demographics
NPI:1912334822
Name:STORY, JESSICA JAYNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JAYNE
Last Name:STORY
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 1:78 POMEROY TER
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3378
Mailing Address - Country:US
Mailing Address - Phone:413-585-1310
Mailing Address - Fax:413-586-1490
Practice Address - Street 1:12165 STATE HIGHWAY 14 N STE B7
Practice Address - Street 2:
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008-9538
Practice Address - Country:US
Practice Address - Phone:505-913-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-09
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-113381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical