Provider Demographics
NPI:1053780619
Name:D ACOSTA, JESSICA LYNN (LCSW LICSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:D ACOSTA
Suffix:
Gender:F
Credentials:LCSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LOBSTER LN.
Mailing Address - Street 2:APT C
Mailing Address - City:CHATHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02633
Mailing Address - Country:US
Mailing Address - Phone:973-922-3551
Mailing Address - Fax:
Practice Address - Street 1:2 LOBSTER LN.
Practice Address - Street 2:APT C
Practice Address - City:CHATHAM
Practice Address - State:MA
Practice Address - Zip Code:02633
Practice Address - Country:US
Practice Address - Phone:973-922-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
44SC057549001041C0700X
NJ44SL06087400104100000X
MA1212821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker