Provider Demographics
NPI:1528778941
Name:REID, JESSICA R (LICSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:REID
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 PROVIDENCE RD APT 905
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01519-1544
Mailing Address - Country:US
Mailing Address - Phone:774-274-0607
Mailing Address - Fax:
Practice Address - Street 1:174 PROVIDENCE RD APT 905
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01519-1544
Practice Address - Country:US
Practice Address - Phone:774-274-0607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1255311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical