Healthcare Provider Details

I. General information

NPI: 1154881811
Provider Name (Legal Business Name): ANNA JESSEMAN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 WISCONSIN AVE NW
WASHINGTON DC
20007-2265
US

IV. Provider business mailing address

6009 5TH ST NW
WASHINGTON DC
20011-1319
US

V. Phone/Fax

Practice location:
  • Phone: 202-944-5400
  • Fax:
Mailing address:
  • Phone: 510-701-4692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50081967
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: