Provider Demographics
NPI:1528616505
Name:WARE, JESSICA LEAH
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEAH
Last Name:WARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73A MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:CT
Mailing Address - Zip Code:06071-1836
Mailing Address - Country:US
Mailing Address - Phone:413-250-5995
Mailing Address - Fax:
Practice Address - Street 1:73A MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:CT
Practice Address - Zip Code:06071-1836
Practice Address - Country:US
Practice Address - Phone:413-250-5995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional