Healthcare Provider Details

I. General information

NPI: 1538766704
Provider Name (Legal Business Name): JESSICA WILSON MORENCY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 CONCORD AVE STE 206
BELMONT MA
02478-3048
US

IV. Provider business mailing address

11 VILLAGE ST APT 4D
SOMERVILLE MA
02143-3728
US

V. Phone/Fax

Practice location:
  • Phone: 781-400-2641
  • Fax:
Mailing address:
  • Phone: 203-258-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10006008
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: