MEDICARE: JESSICA MARCHESE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW.09929935	CO

General Provider Information

NPI Number	:	1972177814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARCHESE LCSW

Provider Business Mailing Address
First Line	:	3230 E WOODMEN RD STE 110
Second Line	:
City	:	COLORADO SPGS
State	:	CO
Zip	:	80920-8502
Country	:	US
Telephone Number	:	719-623-2356
Fax Number	:

Provider Business Practice Location Address
First Line	:	3230 E WOODMEN RD STE 110
Second Line	:
City	:	COLORADO SPGS
State	:	CO
Zip	:	80920-8502
Country	:	US
Telephone Number	:	719-623-2356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2021
Last Update Date	:	04/16/2024

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