Healthcare Provider Details

I. General information

NPI: 1730199233
Provider Name (Legal Business Name): JEANNE BRANCH WESS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 CEDAR ST
WORCESTER MA
01609-2134
US

IV. Provider business mailing address

39 BROOKDALE CIR
SHREWSBURY MA
01545-5442
US

V. Phone/Fax

Practice location:
  • Phone: 508-754-7178
  • Fax:
Mailing address:
  • Phone: 508-754-7178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104860
License Number StateMA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: