Provider Demographics
NPI:1386439537
Name:JESSICA K MANN LLC
Entity type:Organization
Organization Name:JESSICA K MANN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW LCADC
Authorized Official - Phone:609-705-1183
Mailing Address - Street 1:435 SAINT MARKS AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2141
Mailing Address - Country:US
Mailing Address - Phone:609-705-1183
Mailing Address - Fax:
Practice Address - Street 1:2208 N PICKETT ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1064
Practice Address - Country:US
Practice Address - Phone:609-705-1183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1154069953Medicaid