Provider Demographics
NPI:1962626952
Name:NAROG, JESSICA KATHLEEN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KATHLEEN
Last Name:NAROG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WALNUT ST
Mailing Address - Street 2:#3
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3024
Mailing Address - Country:US
Mailing Address - Phone:860-539-6126
Mailing Address - Fax:
Practice Address - Street 1:439 S. UNION ST.
Practice Address - Street 2:MSPCC
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-2451
Practice Address - Country:US
Practice Address - Phone:978-682-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist