Provider Demographics
NPI:1861200420
Name:MUNIZ, JESSICA N (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6348 NEW JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46323-1259
Mailing Address - Country:US
Mailing Address - Phone:219-290-3222
Mailing Address - Fax:
Practice Address - Street 1:6348 NEW JERSEY AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46323-1259
Practice Address - Country:US
Practice Address - Phone:219-290-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010485A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical