Provider Demographics
NPI:1316249691
Name:STUCKER, JESSICA (LICSW, MLADC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:STUCKER
Suffix:
Gender:F
Credentials:LICSW, MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MIDDLE ST STE 223
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4391
Mailing Address - Country:US
Mailing Address - Phone:857-302-0313
Mailing Address - Fax:603-766-0009
Practice Address - Street 1:1 MIDDLE ST STE 223
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4391
Practice Address - Country:US
Practice Address - Phone:857-302-0313
Practice Address - Fax:603-766-0009
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1017101YA0400X
NH19471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)