Provider Demographics
NPI:1124479688
Name:BEMBAS, JESSICA LOVE (LLBSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LOVE
Last Name:BEMBAS
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LOVE
Other - Last Name:ECKMETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1533 CADILLAC BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-3107
Mailing Address - Country:US
Mailing Address - Phone:313-832-3100
Mailing Address - Fax:
Practice Address - Street 1:3430 3RD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2202
Practice Address - Country:US
Practice Address - Phone:313-832-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6852089055104100000X
MI6802089055104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker