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General NPI Number Information
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NPI Number | 1194586099
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Entity Type | Individual
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Provider Name | JESSICA DEARDORFF LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/17/2024
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 340 S LEMON AVE STE 9892
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City | WALNUT
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State | CA
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Zip | 91789-2706
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Country | US
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Telephone | 415-645-5759
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Fax |
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Provider Business Mailing Address
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Address Line | 113 MUSTANG LN
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City | BERKELEY SPRINGS
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State | WV
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Zip | 25411-6955
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Country | US
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Telephone | 443-472-3417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | DP00945771
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License Number State | WV
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