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General NPI Number Information
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NPI Number | 1841328580
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Entity Type | Individual
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Provider Name | DEBORAH A. JESDALE LICSW, LMHC
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Gender | Female
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 92 MAIN RD FL 2
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City | TIVERTON
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State | RI
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Zip | 02878-1126
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Country | US
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Telephone | 401-624-7473
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Fax | 401-683-2109
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Provider Business Mailing Address
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Address Line | 155 MAIN RD
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City | TIVERTON
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State | RI
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Zip | 02878-1236
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Country | US
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Telephone | 401-624-7473
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | ISW01065
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License Number State | RI
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