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General NPI Number Information
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NPI Number | 1679093629
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Entity Type | Individual
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Provider Name | JESSICA FRESH LICSW
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Gender | Female
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 1011 VETERANS MEMORIAL PKWY
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City | RIVERSIDE
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State | RI
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Zip | 02915-5061
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Country | US
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Telephone | 401-432-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 12 HARRIS AVE
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City | WARREN
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State | RI
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Zip | 02885-2308
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Country | US
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Telephone |
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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 | 119785
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License Number State | MA
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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 | ISW02964
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License Number State | RI
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