Provider Demographics
NPI:1851574552
Name:LARGE, JESSICA M (MA, EDS LPC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:M
Last Name:LARGE
Suffix:
Gender:
Credentials:MA, EDS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LLOYD AVE
Mailing Address - Street 2:
Mailing Address - City:STANHOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07874-2925
Mailing Address - Country:US
Mailing Address - Phone:973-713-3034
Mailing Address - Fax:973-512-3700
Practice Address - Street 1:281 STATE ROUTE 10 E STE 4
Practice Address - Street 2:
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1375
Practice Address - Country:US
Practice Address - Phone:973-814-4128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00410400101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health