Basic Information
| Provider Information | |||||||||
| NPI: | 1093033854 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOWNE | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 LILLIANS WAY | ||||||||
| Address2: | |||||||||
| City: | ERVING | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013444422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132186217 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 58 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | BERNARDSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013378500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132186217 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2010 | ||||||||
| LastUpdateDate: | 01/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 215874 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 116873 | 01 | MA | COMMONWEALTH OF MASSACHUSETTS | OTHER |