MEDICARE: JESSICA MARIE RICH MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1164802583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARIE RICH MSW

Provider Business Mailing Address
First Line	:	1470 CONNERS LN
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-3826
Country	:	US
Telephone Number	:	407-687-6677
Fax Number	:

Provider Business Practice Location Address
First Line	:	1470 CONNERS LN
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-3826
Country	:	US
Telephone Number	:	407-687-6677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2015
Last Update Date	:	06/01/2015

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