Provider Demographics
NPI:1437799681
Name:GRAVEL, JESSICA LYNNE (LICSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:GRAVEL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNNE
Other - Last Name:BENOIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:49 MILL STREET
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-2235
Mailing Address - Country:US
Mailing Address - Phone:774-766-7483
Mailing Address - Fax:
Practice Address - Street 1:49 MILL STREET
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-2235
Practice Address - Country:US
Practice Address - Phone:774-766-7483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1228631041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical