Provider Demographics
NPI:1366980849
Name:HEMESATH, JESSICA
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:HEMESATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:LAKE HELEN
Mailing Address - State:FL
Mailing Address - Zip Code:32744-3503
Mailing Address - Country:US
Mailing Address - Phone:386-479-8649
Mailing Address - Fax:
Practice Address - Street 1:2400 S RIDGEWOOD AVE
Practice Address - Street 2:STE. 32
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-3097
Practice Address - Country:US
Practice Address - Phone:386-304-7600
Practice Address - Fax:386-304-7620
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW108141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical