Healthcare Provider Details

I. General information

NPI: 1184627184
Provider Name (Legal Business Name): JESSICA A REED LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/20/2006

III. Provider practice location address

8 OLD GREENDALE AVE
NEEDHAM MA
02492-4424
US

IV. Provider business mailing address

8 OLD GREENDALE AVE
NEEDHAM MA
02492-4424
US

V. Phone/Fax

Practice location:
  • Phone: 508-930-2342
  • Fax: 781-449-6210
Mailing address:
  • Phone: 508-930-2342
  • Fax: 781-449-6210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1020965
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP07529
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: