Provider Demographics
NPI:1194295303
Name:RAMIREZ, JESSICA BELEN (MFT, MFTPCC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BELEN
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:MFT, MFTPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 CUMMINS DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-6400
Mailing Address - Country:US
Mailing Address - Phone:209-576-1750
Mailing Address - Fax:
Practice Address - Street 1:2423 W MARCH LN STE 200
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8250
Practice Address - Country:US
Practice Address - Phone:209-478-9862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
CA136833101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician