Healthcare Provider Details

I. General information

NPI: 1578385134
Provider Name (Legal Business Name): JESSICA MARTINE ZIPIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 LOCUST ST
PHILADELPHIA PA
19103-6305
US

IV. Provider business mailing address

7006 BOYER ST APT 1
PHILADELPHIA PA
19119
US

V. Phone/Fax

Practice location:
  • Phone: 301-801-9059
  • Fax:
Mailing address:
  • Phone: 301-801-9059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW024988
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: