Provider Demographics
NPI:1528258100
Name:UMBRELL, JESSICA R (PSYD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:UMBRELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 WILLIAM PENN WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6737
Mailing Address - Country:US
Mailing Address - Phone:717-391-6808
Mailing Address - Fax:717-391-0709
Practice Address - Street 1:1850 WILLIAM PENN WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6737
Practice Address - Country:US
Practice Address - Phone:717-391-6808
Practice Address - Fax:717-391-0709
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016254103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist