Provider Demographics
NPI:1154134385
Name:PANICCIA, JESSICA RENEE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RENEE
Last Name:PANICCIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8134 NEW LAGRANGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUSIVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222
Mailing Address - Country:US
Mailing Address - Phone:502-830-9276
Mailing Address - Fax:502-690-4500
Practice Address - Street 1:8134 NEW LAGRANGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUSIVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222
Practice Address - Country:US
Practice Address - Phone:502-830-9276
Practice Address - Fax:502-690-4500
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY2571231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical