MEDICARE: JESSICA LYNN DE LEON M.A.

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	103TC0700X	Clinical Psychologist	000000000000000	MD

General Provider Information

NPI Number	:	1255190591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LYNN DE LEON M.A.

Provider Business Mailing Address
First Line	:	1102 LINCOLN WAY # 1102
Second Line	:
City	:	NEW FREEDOM
State	:	PA
Zip	:	17349-9547
Country	:	US
Telephone Number	:	717-965-6654
Fax Number	:

Provider Business Practice Location Address
First Line	:	1102 LINCOLN WAY # 1102
Second Line	:
City	:	NEW FREEDOM
State	:	PA
Zip	:	17349-9547
Country	:	US
Telephone Number	:	717-965-6654
Fax Number	:

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

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	03/18/2024

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