Provider Demographics
NPI:1205635604
Name:COTTER, JESSICA LEIGH (LICSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:COTTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JESS
Other - Middle Name:
Other - Last Name:COTTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:10 ALLEN AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-6800
Mailing Address - Country:US
Mailing Address - Phone:510-914-8426
Mailing Address - Fax:
Practice Address - Street 1:10 ALLEN AVE APT 3
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6800
Practice Address - Country:US
Practice Address - Phone:510-914-8426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW040781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical