Provider Demographics
NPI:1205431558
Name:PHIPPS, JESSICA (LSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3143
Mailing Address - Country:US
Mailing Address - Phone:908-922-8500
Mailing Address - Fax:
Practice Address - Street 1:1433 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3143
Practice Address - Country:US
Practice Address - Phone:908-922-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL04702800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker