MEDICARE: JESSICA LUDDY-FERNANDEZ LICSW

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	118524	MA
2	1041C0700X	Clinical Social Worker	2844	NH

General Provider Information

NPI Number	:	1669733325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LUDDY-FERNANDEZ LICSW

Provider Business Mailing Address
First Line	:	33 PLEASANT ST
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-4004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 PLEASANT ST
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-4004
Country	:	US
Telephone Number	:	603-451-2371
Fax Number	:

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

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	08/15/2025

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