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General NPI Number Information
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NPI Number | 1982394219
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Entity Type | Individual
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Provider Name | JESSICA REMY LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/10/2023
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 322 EAST MAIN ST SUITE 1A US RENAL CARE
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City | BRANFORD
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State | CT
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Zip | 06405
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Country | US
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Telephone | 203-483-0710
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Fax |
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Provider Business Mailing Address
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Address Line | 322 E MAIN ST STE 1A
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City | BRANFORD
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State | CT
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Zip | 06405-3136
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Country | US
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Telephone | 203-483-0710
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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 | 122857-01
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License Number State | NY
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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 | LICSW128117
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 009652
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License Number State | CT
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