Provider Demographics
NPI:1164256210
Name:FAUST, JESSICA ANNE (LMSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:FAUST
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CAMERON AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1158
Mailing Address - Country:US
Mailing Address - Phone:413-530-1615
Mailing Address - Fax:
Practice Address - Street 1:7 CAMERON AVE APT 305
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1158
Practice Address - Country:US
Practice Address - Phone:413-274-7941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1244271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical