| Jessica Stucker, Licsw, Mladc | |
|
1 Middle St Ste 223 Portsmouth NH 03801-4391 | |
| (857) 302-0313 | |
| (603) 766-0009 |
| Full Name | Jessica Stucker, Licsw, Mladc |
|---|---|
| Speciality | Social Worker |
| Location | 1 Middle St Ste 223, Portsmouth, New Hampshire |
| Authorized Official Name and Position | Jessica Stucker (MANAGER) |
| Authorized Official Contact | 8573020313 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jessica Stucker, Licsw, Mladc 1 Middle St Ste 223 Portsmouth NH 03801-4391 Ph: (857) 302-0313 | Jessica Stucker, Licsw, Mladc 1 Middle St Ste 223 Portsmouth NH 03801-4391 Ph: (857) 302-0313 |
| NPI Number | 1629682141 |
|---|---|
| Provider Enumeration Date | 09/02/2020 |
| Last Update Date | 11/11/2020 |
| Certification Date | 11/11/2020 |
| Medicare PECOS PAC ID | 5193133189 |
|---|---|
| Medicare Enrollment ID | O20210412001369 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629682141 | NPI | - | NPPES |
| 3114304 | Medicaid | NH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jessica Stucker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316249691 PECOS PAC ID: 4789969643 Enrollment ID: I20190610001926 |
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