Provider Demographics
NPI:1356047989
Name:JESSICA WEBSTER PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:JESSICA WEBSTER PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC, LADC
Authorized Official - Phone:802-309-6979
Mailing Address - Street 1:25 BACON ST UNIT 402
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-4496
Mailing Address - Country:US
Mailing Address - Phone:802-309-6979
Mailing Address - Fax:
Practice Address - Street 1:25 BACON ST UNIT 402
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-4496
Practice Address - Country:US
Practice Address - Phone:802-309-6979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty