Provider Demographics
NPI:1437342839
Name:PARRY, JAMIE ROSE (MA)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:ROSE
Last Name:PARRY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:ROSE
Other - Last Name:FEDDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:640 FREEDOM BUSINESS CTR DR STE 220
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1376
Mailing Address - Country:US
Mailing Address - Phone:480-650-0792
Mailing Address - Fax:
Practice Address - Street 1:325 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704-1703
Practice Address - Country:US
Practice Address - Phone:480-650-0792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH006823103K00000X
1-06-3182103K00000X
WACL60166749101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor