Provider Demographics
NPI:1124618517
Name:SMITH-O'CONNOR, JESSICA FRENCH (LGSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:FRENCH
Last Name:SMITH-O'CONNOR
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1238 K ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-4114
Mailing Address - Country:US
Mailing Address - Phone:631-681-4114
Mailing Address - Fax:
Practice Address - Street 1:502 KENNEDY ST NW STE 2-A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3010
Practice Address - Country:US
Practice Address - Phone:202-743-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50083430104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCLG50083430OtherDEPARTMENT OF HEALTH GRADUATE SOCIAL WORK LICENSE