Provider Demographics
NPI:1285143180
Name:MARTIN, JESSICA LEIGH (MA)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LEIGH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3723 DEL PRADO BLVD S STE A
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7124
Mailing Address - Country:US
Mailing Address - Phone:239-540-1155
Mailing Address - Fax:
Practice Address - Street 1:3723 DEL PRADO BLVD S STE A
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7124
Practice Address - Country:US
Practice Address - Phone:239-540-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health