Provider Demographics
NPI:1760200976
Name:JESSURUN, BRITTANY MIRANDA (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:BRITTANY
Middle Name:MIRANDA
Last Name:JESSURUN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:BRITTANY
Other - Middle Name:MIRANDA
Other - Last Name:BLANKENSHIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6611 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-4902
Mailing Address - Country:US
Mailing Address - Phone:571-479-2309
Mailing Address - Fax:
Practice Address - Street 1:6611 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-4902
Practice Address - Country:US
Practice Address - Phone:571-479-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040173981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical