Provider Demographics
NPI:1982091245
Name:GADD, JESSIE (LICSW)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:GADD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1203
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03874-1203
Mailing Address - Country:US
Mailing Address - Phone:603-997-1496
Mailing Address - Fax:
Practice Address - Street 1:24 BATCHELDER RD
Practice Address - Street 2:115 B10
Practice Address - City:SEABROOK
Practice Address - State:NH
Practice Address - Zip Code:03874-4401
Practice Address - Country:US
Practice Address - Phone:603-997-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1172031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical