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NPI Code Detail

MEDICARE: JESSICA GERSHWIN LCSW

MEDICARE: JESSICA GERSHWIN LCSW
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
11041C0700XClinical Social Worker09924025CO

General Provider Information

NPI Number : 1386029916
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA GERSHWIN LCSW
Provider Business Mailing Address
First Line : 9551 W 38TH AVE
Second Line :
City : WHEAT RIDGE
State : CO
Zip : 80033-4225
Country : US
Telephone Number : 720-220-7525
Fax Number :
Provider Business Practice Location Address
First Line : 2149 FEDERAL BLVD
Second Line :
City : DENVER
State : CO
Zip : 80211-4639
Country : US
Telephone Number : 303-825-3850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2015
Last Update Date : 07/24/2015

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