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General NPI Number Information
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NPI Number | 1780191726
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Entity Type | Organization
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Legal Business Name | JESSICA PRODIS LICSW
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Dates
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Enumeration Date | 12/29/2017
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 30 FLORENCE AVE
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City | HOLYOKE
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State | MA
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Zip | 01040-1813
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Country | US
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Telephone | 413-687-8239
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Fax |
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Provider Business Mailing Address
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Address Line | 30 FLORENCE AVE
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City | HOLYOKE
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State | MA
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Zip | 01040-1813
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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 | SUPERVISING CLINICIAN
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Name | JESSICA JEANNE PRODIS
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Credential | LICSW
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Telephone | 413-687-8239
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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 | 118495
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License Number State | MA
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