Healthcare Provider Details

I. General information

NPI: 1730413725
Provider Name (Legal Business Name): JESSICA ANN GRANT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ANN NEAGLE-GILLON

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 03/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CONDOR ST
EAST BOSTON MA
02128-1305
US

IV. Provider business mailing address

31 COUNTY ST
DEDHAM MA
02026-4107
US

V. Phone/Fax

Practice location:
  • Phone: 617-569-6560
  • Fax: 617-569-1856
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: