Provider Demographics
NPI:1568277382
Name:HASSANI, JESSICA (MED, PPSC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HASSANI
Suffix:
Gender:F
Credentials:MED, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2498
Mailing Address - Country:US
Mailing Address - Phone:831-464-5655
Mailing Address - Fax:
Practice Address - Street 1:2700 PORTER ST
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2498
Practice Address - Country:US
Practice Address - Phone:831-464-5655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240244070101YS0200X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool