Provider Demographics
NPI:1619773884
Name:STEIN, JESSICA ANN (LMSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:STEIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 GINGLIS WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7748
Mailing Address - Country:US
Mailing Address - Phone:516-661-2821
Mailing Address - Fax:
Practice Address - Street 1:1037 CHUCK DAWLEY BLVD STE 209-D
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4146
Practice Address - Country:US
Practice Address - Phone:843-352-8667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPIC355104100000X
SC15422104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker