Provider Demographics
NPI:1538257639
Name:AHEARN, JESSICA RAE (LCSW)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:RAE
Last Name:AHEARN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:R
Other - Last Name:FRIEDMAN-AHEARN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:550 S. VERMONT,
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1912
Mailing Address - Country:US
Mailing Address - Phone:213-639-6733
Mailing Address - Fax:213-384-0729
Practice Address - Street 1:550 S VERMONT AVE
Practice Address - Street 2:3RD FLOOR LA COUNTY DEPT OF MENTAL HEALTH
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1912
Practice Address - Country:US
Practice Address - Phone:213-639-6733
Practice Address - Fax:213-384-0729
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 97501041C0700X
CALCS97501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical