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General NPI Number Information
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NPI Number | 1356599583
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Entity Type | Individual
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Provider Name | JESSICA E SPISSINGER PA, LICSW
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Gender | Female
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Dates
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Enumeration Date | 08/29/2008
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Last Update Date | 10/25/2013
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Provider Practice Location Address
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Address Line | 43 STEDMAN ST
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City | QUINCY
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State | MA
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Zip | 02169-1220
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Country | US
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Telephone | 773-240-7492
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Fax |
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Provider Business Mailing Address
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Address Line | 43 STEDMAN ST
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City | QUINCY
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State | MA
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Zip | 02169-1220
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Country | US
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Telephone | 773-240-7492
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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 | 149012972
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 23936
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA4763
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 117721
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License Number State | MA
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