Provider Demographics
NPI:1306237151
Name:MATTHEWS, JESSICA B (MSED, LMSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:B
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MSED, LMSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:BETH
Other - Last Name:BLANCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED, LMSW
Mailing Address - Street 1:914 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4708
Mailing Address - Country:US
Mailing Address - Phone:917-991-0582
Mailing Address - Fax:
Practice Address - Street 1:914 AVENUE L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4708
Practice Address - Country:US
Practice Address - Phone:917-991-0582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090001104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker