Provider Demographics
NPI:1366417701
Name:BARTON, JESSICA J (LICSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:J
Last Name:BARTON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HANCOCK ST
Mailing Address - Street 2:#209
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3188
Mailing Address - Country:US
Mailing Address - Phone:617-354-8687
Mailing Address - Fax:
Practice Address - Street 1:49 HANCOCK ST
Practice Address - Street 2:#209
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3188
Practice Address - Country:US
Practice Address - Phone:617-354-8687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1015818104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04747OtherBLUE CROSS
MAP04747OtherBLUE CROSS