Provider Demographics
NPI:1144982208
Name:PREZORSKI, JESSICA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:PREZORSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 HARRISON AVE STE G-101
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3124
Mailing Address - Country:US
Mailing Address - Phone:914-715-9103
Mailing Address - Fax:
Practice Address - Street 1:1600 HARRISON AVE STE G-101
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3124
Practice Address - Country:US
Practice Address - Phone:914-715-9103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070567-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNONEOtherNONE