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NPI Code Detail

MEDICARE: JESSICA YARDLEY PICKENS-PHILLIPS LCSW-C

MEDICARE:   JESSICA YARDLEY PICKENS-PHILLIPS  LCSW-C
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
11041C0700XClinical Social Worker24072MD

General Provider Information

NPI Number : 1972184075
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA YARDLEY PICKENS-PHILLIPS LCSW-C
Provider Business Mailing Address
First Line : 1203 FIDLER LN APT 1412
Second Line :
City : SILVER SPRING
State : MD
Zip : 20910-7410
Country : US
Telephone Number : 914-409-8660
Fax Number :
Provider Business Practice Location Address
First Line : 1203 FIDLER LN APT 1412
Second Line :
City : SILVER SPRING
State : MD
Zip : 20910-7410
Country : US
Telephone Number : 914-409-8660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2021
Last Update Date : 04/20/2021

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Directions to “ JESSICA YARDLEY PICKENS-PHILLIPS LCSW-C” Practice Location

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